Prevalence of abdominal aortic aneurysms in four different metropolitan areas in Mexico.

OBJECTIVE: Epidemiological data on aneurysmal disease affecting the abdominal aorta in Latin American countries are limited. In our institution, the National Institute of Medical Sciences and Nutrition Salvador Zubiran (INCMNSZ), we have reported an Abdominal Aortic Aneurysm (AAA) prevalence of 3.26% in patients at risk from our Ultrasound (US) screening program. We aim to determine and compare the prevalence of undetected AAA in four different Metropolitan areas in Mexico to justify further US screening efforts. METHODS: A cross-sectional multicenter study was conducted in 9 different academic institutions. Abdominal Computed Tomographies (CT) from patients with age equal or greater than 55 years in our center (INCMNSZ), and in 65 year old patients and older in the remainder institutions were systematically reviewed. Abdominal aortic diameters were measured at the level of the superior (SMA) and inferior mesenteric arteries (IMA) in nonaneurysmal aortas and maximum diameters in the found AAA. Categorical data were analyzed by nonparametric statistic test at significance level (P < 0.05), the Pearson test was used to determine the correlation of age and aortic diameters. RESULTS: The cohort included a total of 12, 936 patients paired with respect gender (53% females, with a mean age of 69 years), the AAA prevalence found in the studied Mexican population was 3.08% (399 AAA patients). In centers where more than 200 CTs scans were reviewed, the prevalence was 4.03%, compared to the 4.63% found in centers with less than 200 studies (P = 0.41). In patients between the ages of 55 to 64 from INCMNSZ (3889 total), the prevalence was 0.77%, supporting the need of focused US-screening programs in individuals at the age of 65 and older in our country. CONCLUSIONS: The introduction of a national US Screening Program for the detection of AAA in Mexico represents a challenge in our current health system. This Multicenter initiative demonstrates that our AAA prevalence is not different to other international reports; imaging screening might represent cost-effective strategy for reduction of aneurysm-related mortality.

Incidence of thrombotic events and complications associated to inferior vena cava filters in patients with and without anticoagulation therapy.

Objective: Anticoagulation is the primary management to prevent venous thromboembolism; inferior vena cava filters (IVCFs) provide a mechanical prophylactic alternative when anticoagulation is contraindicated. The aim of this study was to evaluate in IVCF patients, whether the initiation of anticoagulation therapy is associated with decreased rates of recurrent thrombotic events and device-related complications. Methods: This was a retrospective review of patients that underwent insertion of IVCF. Subjects with IVCF were studied in two groups: those initiated on anticoagulation (A) and without anticoagulation (NA). Variables as indications for IVCF, anticoagulation, recurrence of thrombosis, complications, and reinterventions were examined. Results: From April 2007 to March 2014, 54 patients underwent IVCF placement; (61% of females), with mean age of 54 years (standard deviation ± 19). 28 (52%) were initiated on anticoagulation, during a mean follow-up period of 28 months, five experienced recurrent thrombosis and three were on the A group (p=0.5); when comparing patients that developed post-thrombotic syndrome, seven were in the A group and seven in the NA. Two patients with IVC rupture were in the A group (p=0.5), and the only case of IVCF migration occurred in the A group. 11 (20%) patients died from comorbidities nonrelated to the device or procedure (four in the A cohort). Conclusions: Patients with IVCF on anticoagulation have equivalent rates of thrombotic events and device-related complications than those patients NA.

Objetivo: La anticoagulación es la terapia de elección para la prevención de tromboembolismo venoso; los filtros de vena cava inferior (FVCI) proveen una alternativa mecánica profiláctica cuando la anticoagulación está contraindicada. El objetivo de este estudio fue evaluar si la terapia anticoagulante se asocia con una tasa menor de eventos trombóticos recurrentes y complicaciones relacionadas con el dispositivo. Métodos: Los pacientes fueron categorizados en dos grupos: Aquellos a los que se les inicio anticoagulación (A) y aquellos que no (NA). Variables tales como indicación de la colocación del filtro, anticoagulación, recurrencia de trombosis y complicaciones fueron examinadas. Resultados: De abril de 2007 a marzo 2014, a 54 pacientes se les coloco un filtro (61% fueron mujeres), con una media de edad de 54 años [Desviación estándar (DE) ±19. Veintiocho (52%) fueron iniciados en anticoagulación y durante un seguimiento de 28 meses, 5 pacientes experimentaron recurrencia de trombosis, 3 en el grupo A (p=0.5). Al comparar los pacientes que desarrollaron síndrome posflebítico, 7 pertenecieron al grupo A y 7 al grupo NA. Dos pacientes con ruptura de vena cava pertenecieron al grupo A (p=0.5) y el único caso de migración del dispositivo ocurrió en el grupo A. Once (20%) pacientes fallecieron debido a comorbilidades no relacionadas con el dispositivo o el procedimiento. Conclusión: Pacientes con FVCI en anticoagulación tienen tasas de eventos trombóticos y complicaciones asociadas a los dispositivos equivalentes a aquellos pacientes sin anticoagulación.

Incidence of thrombotic events and complications associated to inferior vena cava filters in patients with and without anticoagulation therapy / Incidencia de eventos trombóticos y complicaciones asociadas al uso de filtros de vena cava en pacientes en pacientes con o sin terapia anticoagulante

Abstract Objective: Anticoagulation is the primary management to prevent venous thromboembolism; inferior vena cava filters (IVCFs) provide a mechanical prophylactic alternative when anticoagulation is contraindicated. The aim of this study was to evaluate in IVCF patients, whether the initiation of anticoagulation therapy is associated with decreased rates of recurrent thrombotic events and device-related complications. Methods: This was a retrospective review of patients that underwent insertion of IVCF. Subjects with IVCF were studied in two groups: those initiated on anticoagulation (A) and without anticoagulation (NA). Variables as indications for IVCF, anticoagulation, recurrence of thrombosis, complications, and reinterventions were examined. Results: From April 2007 to March 2014, 54 patients underwent IVCF placement; (61% of females), with mean age of 54 years (standard deviation ± 19). 28 (52%) were initiated on anticoagulation, during a mean follow-up period of 28 months, five experienced recurrent thrombosis and three were on the A group (p=0.5); when comparing patients that developed post-thrombotic syndrome, seven were in the A group and seven in the NA. Two patients with IVC rupture were in the A group (p=0.5), and the only case of IVCF migration occurred in the A group. 11 (20%) patients died from comorbidities nonrelated to the device or procedure (four in the A cohort). Conclusions: Patients with IVCF on anticoagulation have equivalent rates of thrombotic events and device-related complications than those patients NA.

Resumen Objetivo: La anticoagulación es la terapia de elección para la prevención de tromboembolismo venoso; los filtros de vena cava inferior (FVCI) proveen una alternativa mecánica profiláctica cuando la anticoagulación está contraindicada. El objetivo de este estudio fue evaluar si la terapia anticoagulante se asocia con una tasa menor de eventos trombóticos recurrentes y complicaciones relacionadas con el dispositivo. Métodos: Los pacientes fueron categorizados en dos grupos: Aquellos a los que se les inicio anticoagulación (A) y aquellos que no (NA). Variables tales como indicación de la colocación del filtro, anticoagulación, recurrencia de trombosis y complicaciones fueron examinadas. Resultados: De abril de 2007 a marzo 2014, a 54 pacientes se les coloco un filtro (61% fueron mujeres), con una media de edad de 54 años [Desviación estándar (DE) ±19. Veintiocho (52%) fueron iniciados en anticoagulación y durante un seguimiento de 28 meses, 5 pacientes experimentaron recurrencia de trombosis, 3 en el grupo A (p=0.5). Al comparar los pacientes que desarrollaron síndrome posflebítico, 7 pertenecieron al grupo A y 7 al grupo NA. Dos pacientes con ruptura de vena cava pertenecieron al grupo A (p=0.5) y el único caso de migración del dispositivo ocurrió en el grupo A. Once (20%) pacientes fallecieron debido a comorbilidades no relacionadas con el dispositivo o el procedimiento. Conclusión: Pacientes con FVCI en anticoagulación tienen tasas de eventos trombóticos y complicaciones asociadas a los dispositivos equivalentes a aquellos pacientes sin anticoagulación.

Incidence of thrombotic events and complications associated to inferior vena cava filters in patients with and without anticoagulation therapy.

Objective: Anticoagulation is the primary management to prevent venous thromboembolism; inferior vena cava filters (IVCFs) provide a mechanical prophylactic alternative when anticoagulation is contraindicated. The aim of this study was to evaluate in IVCF patients, whether the initiation of anticoagulation therapy is associated with decreased rates of recurrent thrombotic events and device-related complications. Methods: This was a retrospective review of patients that underwent insertion of IVCF. Subjects with IVCF were studied in two groups: those initiated on anticoagulation (A) and without anticoagulation (NA). Variables as indications for IVCF, anticoagulation, recurrence of thrombosis, complications, and reinterventions were examined. Results: From April 2007 to March 2014, 54 patients underwent IVCF placement; (61% of females), with mean age of 54 years (standard deviation ± 19). 28 (52%) were initiated on anticoagulation, during a mean follow-up period of 28 months, five experienced recurrent thrombosis and three were on the A group (p=0.5); when comparing patients that developed post-thrombotic syndrome, seven were in the A group and seven in the NA. Two patients with IVC rupture were in the A group (p=0.5), and the only case of IVCF migration occurred in the A group. 11 (20%) patients died from comorbidities nonrelated to the device or procedure (four in the A cohort). Conclusions: Patients with IVCF on anticoagulation have equivalent rates of thrombotic events and device-related complications than those patients NA.

Objetivo: La anticoagulación es la terapia de elección para la prevención de tromboembolismo venoso; los filtros de vena cava inferior (FVCI) proveen una alternativa mecánica profiláctica cuando la anticoagulación está contraindicada. El objetivo de este estudio fue evaluar si la terapia anticoagulante se asocia con una tasa menor de eventos trombóticos recurrentes y complicaciones relacionadas con el dispositivo. Métodos: Los pacientes fueron categorizados en dos grupos: Aquellos a los que se les inicio anticoagulación (A) y aquellos que no (NA). Variables tales como indicación de la colocación del filtro, anticoagulación, recurrencia de trombosis y complicaciones fueron examinadas. Resultados: De abril de 2007 a marzo 2014, a 54 pacientes se les coloco un filtro (61% fueron mujeres), con una media de edad de 54 años [Desviación estándar (DE) ± 19. Veintiocho (52%) fueron iniciados en anticoagulación y durante un seguimiento de 28 meses, 5 pacientes experimentaron recurrencia de trombosis, 3 en el grupo A (p=0.5). Al comparar los pacientes que desarrollaron síndrome posflebítico, 7 pertenecieron al grupo A y 7 al grupo NA. Dos pacientes con ruptura de vena cava pertenecieron al grupo A (p=0.5) y el único caso de migración del dispositivo ocurrió en el grupo A. Once (20%) pacientes fallecieron debido a comorbilidades no relacionadas con el dispositivo o el procedimiento. Conclusión: Pacientes con FVCI en anticoagulación tienen tasas de eventos trombóticos y complicaciones asociadas a los dispositivos equivalentes a aquellos pacientes sin anticoagulación.

Malignant Shamblin III Carotid Body Tumors Resected with Use of the Retrocarotid Dissection Technique in 2 Patients.

Carotid body tumors are rare neoplasms with malignant potential in 6% to 12.5% of cases, and surgical resection is the only cure. We present the cases of 2 female patients who had expanding, painless, right-sided neck masses; computed tomographic angiograms revealed Shamblin III tumors at the carotid bifurcation. Each patient underwent tumor resection with use of the retrocarotid dissection technique. The tumor specimens were histologically consistent with malignancy, and free margins were achieved. The patients remained free of symptoms, local recurrence, and metastasis 44 and 19 months after their respective procedures. These are the first malignant Shamblin III carotid body tumors that we have resected by means of retrocarotid dissection. In addition to our patients' cases, we discuss carotid body tumors and compare the retrocarotid and standard caudocranial resection techniques.

Ex Vivo Repair of a Renal Artery Saccular Aneurysm in a Living-Nonrelated Donor and Subsequent Successful Kidney Transplantation.

The use of kidney grafts with aneurysmal disease involving the renal arteries for transplantation is very uncommon and relatively controversial. We herein present the case of a 52-year-old woman who volunteered to become a living-nonrelated donor; during the preoperative imaging workup, a computed tomography angiography revealed a 1.5-cm saccular aneurysm in the left kidney, while the contralateral renal artery was normal. We decided to utilize the left kidney for a 25-year-old male patient with end-stage renal disease, and following the ex vivo repair using the recipient epigastric vessels and saphenous veins, we completed the transplantation in the right pelvic fossa. The postoperative period was uneventful, and at 8 months from the surgery, the graft remains functional. The surgical repair of renal artery aneurysms followed by immediate kidney transplantation is a safe technique and an effective replacement therapy for recipients. The incidental finding of isolated aneurysmal disease in renal arteries should not exclude graft potential availability for transplantation following repair.

Early cannulation graft Flixene™ for conventional and complex hemodialysis access creation.

PURPOSE: The Flixene™ (Atrium™, Hudson, NH) is a trilaminate composite polytetrafluoroethylene (PTFE) graft that allows access within 72 hours. We evaluate our initial experience with this device for conventional and complex hemodialysis access creation. METHODS: Retrospective review in end-stage renal disease (ESRD) patients who underwent access creation with Flixene from January 2013 to July 2014. For our analysis, the patients were divided in two groups: those with complex access configurations tunneled in the chest and/or abdominal wall (thoraco-abdominal wall access [TAWA]), and those tunneled in conventional sites (extremity access [EA]). Patient's demographics, indications, complications, reinterventions, patency rates and factors influencing outcomes were evaluated. RESULTS: In 19 patients (54% men; mean age 44 years ± 18), 24 grafts were implanted, (13 EA [54%] vs. 11 TAWA), all patent after surgery. Central venous occlusive disease (CVOD) was present in all patients with TAWA and in 7/13 (54%) EA patients (p = 0.016). Early cannulation (within 72 hours) was successful in 12 EA and 5 TAWA grafts (p = 0.044). Complication rates including infection, thrombosis, bleeding and steal syndrome were 8/11 (73%) in TAWA and 5/13 (38%) in EA (p = 0.02). At 12 months, primary patency rates for EA and TAWA were 25% and 41%; secondary patency rates were 55% and 41%, respectively. CONCLUSIONS: Early cannulation (EC) grafts are viable alternatives for conventional and complex access creation that allowed early cannulation (<72 hours) in 17 (70%) of our cases. Primary and secondary patency rates at 12 months were equivalent to data reported on ePTFE grafts.