Translation and adaptation to Spanish of Aberdeen varicose veins questionnaire.

OBJECTIVE: The purpose of the study is to translate the Aberdeen Varicose Vein Questionnaire (AVVQ) into Spanish and evaluate the feasibility and reliability of the Spanish-translated AVVQ in patients with chronic venous disease. METHODS: Reliability was assessed by test and retest of the Spanish translated AVVQ in a sample of 77 patients. The questionnaires were answered within a 2-week interval. RESULTS: There was a 100% test and retest response. The AVVQ showed 6.5% of missing responses. Cronbach's alpha was 0.71 indicating an adequate level of internal consistency. Spearman's rho showed a significant strong association between test and retest scores (rho = 0.84, p < 0.0001). CONCLUSIONS: The Spanish-translated AVVQ is a reliable tool in our daily clinical practice in order to measure the impact of venous disease in the quality of life.

Outcomes of the Repair of 1000 Abdominal Aortic Aneurysms in the Endovascular Era.

BACKGROUND: To analyze the outcome of abdominal aortic aneurysm (AAA) repair with elective open surgery (OS) versus endovascular aneurysm repair (EVAR) and assess the predictors of survival. METHODS: A retrospective cohort study was made of 1000 AAA treated between January 1998 and November 2014 (68.1% OS and 31.9% EVAR), with the comparison of comorbidity and complications, and survival analysis (Kaplan-Meier and Breslow). Multivariate logistic regression and Cox regression analyses were performed. RESULTS: The EVAR group had a higher prevalence of smokers (33.2% vs. 21%; P < 0.001), hypercholesterolemia (56.4% vs. 41.1%; P < 0.001), type 1 diabetes (11.3% vs. 2.8%; P < 0.001), ischemic heart disease (36.4% vs. 25.0%; P = 0.013), chronic renal failure (25.4% vs. 16.2%; P < 0.001), and an older age [74.6 ± 7.1 vs. 68.3 ± 7.2 (years); P < 0.001]. The OS group showed a greater prevalence of chronic ischemia of the lower extremities (22.8% vs. 9.4%; P < 0.001), a greater AAA diameter [61.2 ± 13.6 vs. 58.5 ± 13.8 (mm); P < 0.001], a greater aneurysm neck diameter [24.1 ± 3.9 vs. 23.3 ± 3.0 (mm); P = 0.002], and a shorter aneurysm neck length [15.1 ± 11.1 vs. 24.0 ± 11.1 (mm); P < 0.001]. Early mortality was low in both groups but higher with OS (1.9% vs. 0.3%; P = 0.046). OS [OR 16.98 (95% CI: 1.97-146.29) (P < 0.001)] and age [OR 1.22 (95% CI: 1.09-1.36) (P < 0.001)] were independent predictors of higher early mortality. However, there was no increase in mortality in the OS group in patients under 73.5 years (P = 0.996), and the differences increased over 73.5 years of age (P = 0.005). There were also more postoperative complications (23.9% vs. 9.7%; P < 0.001) and early reinterventions in the OS group (4.4% vs. 1.6%; P = 0.026). Only the prevalence of renal function impairment was greater in the EVAR group (6.6% vs. 3.5%; P = 0.034), but this complication resulted not significative in the multivariate analysis [OR 0.84 (95% CI: 0.41-1.69) (P = 0.618)]. The median duration of follow-up was 33 (range 0-175) and 59 months (range 0-190) for the EVAR and OS groups, respectively. The survival rate after 24 and 48 months was 92.9% and 83.9% (EVAR) versus 94.6% and 90.6% (OS) (P < 0.001). This difference was not significative in the multivariable analysis: hazard ratio (HR) 1.46 (95% CI 0.99 to 2.12); P = 0.060. OS also resulted in better freedom from reintervention rates for the same periods: 92.1% and 90.4% versus 92.9% and 88.1%, including multivariate analysis [HR 1.93 (95% CI 1.27 to 2.93) P = 0.002]. The factors independently associated to poorer survival were age [HR 1.09 (1.06-1.11); P < 0.001], chronic obstructive pulmonary disease [HR 1.39 (1.04-1.86); P = 0.026], and chronic renal failure [HR 2.08 (1.51-2.87); P < 0.001]. CONCLUSIONS: Elective AAA repair offers excellent middle-term outcomes with both OS and EVAR. EVAR reduces early mortality in the subgroup of patients older than 73.5 years. In patients younger than 73.5 years with a low to moderate surgical risk, EVAR offers no advantage over OS and therefore should not be regarded as the treatment of choice.

Outcomes of the Endovascular Treatment of Stenotic Lesions versus Chronic Total Occlusions in the Iliac Sector.

BACKGROUND: This study compares outcomes of the endovascular treatment (EVT) of iliac artery occlusive disease according to whether the treated lesion is a stenosis or a chronic total occlusion (CTO). METHODS: Patients undergoing EVT from 2003 to 2013 for iliac artery occlusive disease were identified and the lesions treated stratified into stenotic (Group 1, n = 375) or CTO (Group 2, n = 87). Patients were followed clinically and hemodynamically (thigh-brachial index, TBI). Comorbidities, procedural factors, and outcomes were compared between the 2 groups using Kaplan-Meier, Breslow, and Cox models. RESULTS: Four hundred sixty-two iliac endovascular procedures in 378 patients were included in a retrospective study. The 2 groups only differed in preprocedural TBI [0.77 (Group 1) vs. 0.67 (Group 2), P < 0.001], lesion length [39.7 mm (Group 1) vs. 49.9 mm (Group 2), P < 0.001], and the use of a covered stent [11.6% (Group 1) vs. 46.2% (Group 2), P < 0.001]. The technical success rate was higher in Group 1 (99.2% vs. 89.7%, P < 0.001). Five early occlusions were recorded in Group 1 and 3 in Group 2 (1.3% vs. 3.8%, P = 0.146). Median follow-up was 34 months (1-113). At 12 and 36 months, stenotic lesions showed better primary (P1) and secondary (P2) patency rates [P1 93.0% and 85.8% vs. 83.1% and 74.7%, hazard ratio (HR) 1.90 (1.15-3.14), P = 0.018; P2 97.8% and 96.8% vs. 93.0% and 87.4%, HR 2.86 (1.39-5.90), P = 0.007] and freedom from reintervention (FFR) rates [91.6% and 83.5% vs. 84.1% and 78.9%, HR 1.51 (0.90-2.53), P = 0.132]. In a multivariate analysis, CTO showed a worse P2 than stenotic lesions [HR 2.81 (1.17-6.76), P = 0.021], yet no differences emerged in P1 [HR 1.41 (0.76-2.63), P = 0.277] or FFR [HR 1.43 (0.79-2.57), P = 0.237]. A lower preprocedural TBI was correlated with a greater risk of EVT failure in terms of patency and FFR (P < 0.05). The use of a stent shorter than 40 mm emerged as a protective factor with an HR for P1 of 3.68 (1.53-8.87) (P = 0.004). CONCLUSIONS: EVT for iliac artery disease offers good outcomes in terms of long-term patency, although improved results were observed here for the treatment of stenotic lesions over CTO. Procedures performed in patients with a lower TBI and the use of a stent >40 mm were related to a worse stent patency.

Impact of the Repositionable C3 Excluder System on the Endovascular Treatment of Abdominal Aortic Aneurysms With Unfavorable Neck Anatomy.

PURPOSE: To analyze the midterm clinical outcomes among patients with favorable and unfavorable neck morphology for endovascular aneurysm repair (EVAR), specifically the impact of the repositionable C3 Excluder stent-graft on type I endoleak in patients with unfavorable neck. METHODS: A retrospective review was conducted of 249 patients (mean age 74.3 years; 241 men) who underwent successful EVAR from January 2000 to December 2014 using either the traditional Excluder (n=140) or the C3 repositionable system (n=109). Unfavorable proximal aortic neck anatomy was defined by length <15 mm, angulation >60°, >50% circumferential thrombus, or >50% neck calcification. By these criteria, unfavorable neck anatomy was present in 71 (28.5%) patients (41 traditional Excluder and 30 C3 Excluder). The main endpoint was the incidence of type Ia endoleak and the need for a proximal cuff according to the type of neck anatomy. Comparisons between groups are reported as the odds ratio (OR) and 95% confidence interval (CI). RESULTS: A proximal extension cuff for type Ia endoleak was needed in 4 (2.2%) patients with favorable neck anatomy compared to 7 (9.9%) patients with unfavorable neck (OR 4.76, 95% CI 1.3 to 16.8, p=0.014). Among the patients with unfavorable neck, a proximal cuff was implanted in 6/41 (14.6%) traditional Excluder stent-grafts vs 1/30 (3.3%) in the C3 Excluder group (OR 4.39, 95% CI 0.55 to 34.58, p=0.23). Median follow-up was 30.5 and 38 months for favorable vs unfavorable neck groups, respectively (p=0.29). Only 1 case of type Ia endoleak was registered at 6.5 years' follow-up (traditional Excluder), with no device migration. CONCLUSION: Both Excluder stent-grafts provide good midterm clinical outcomes after EVAR in patients with unfavorable neck anatomy. Investigation of a larger cohort will be needed to identify if the C3 Excluder device offers any improvement over the traditional Excluder in terms of freedom from endoleaks.

Clinical Outcomes after Endovascular Treatment Failure in Patients with Femoropopliteal Occlusive Disease.

BACKGROUND: To analyze the clinical impact derived from endovascular treatment failure on patients with femoropopliteal occlusive disease (FPOD) regarding their preoperative clinical stage. METHODS: Retrospective review for primary endovascular procedures for FPOD from 2008 to 2013. Primary end point included clinical deterioration defined as acute limb ischemia (ALI) or clinical worsening by, at least, one Rutherford's classification category, related to procedure's failure (restenosis >70% or occlusion). RESULTS: Ninety procedures were analyzed in 85 patients, 87.8% operated due to critical limb ischemia. The lesion treated was classified as Trans-Atlantic Inter-Society Consensus (TASC)-A/B in 76.7%, with a mean length of 98.5 ± 54 mm. Covered stent graft (SG) was used in 31.1% of the cases. Median follow-up was 14.5 months and treatment failure occurred in 33.3% of cases (n = 30, 9 restenosis and 21 occlusions). Clinical worsening was assessed in 40% of treatment failures and 6 of 21 (28.6%) presented as ALI. Twenty-two major adverse limb events (MALEs) were recorded and 8 major amputations. Regarding the type of stent, more occlusions were recorded on patients treated with SG compared with bare metal stent (39.3% vs. 16%; P = 0.02). However, no differences were found between groups regarding clinical worsening attributable to treatment failure (HR, 1.33; CI 95%, 0.5-3.5; P = 0.5). On multivariate analysis, TASC-C/D lesions (HR, 5.5; CI 95%, 2.3-13.3; P < 0.001) and female sex (HR, 4.9; CI 95%, 1.9-12.5; P = 0.001) behaved as significant predictors for failure and dual-antiplatelet therapy as a protective factor (HR, 0.3; CI 95%, 0.3-0.13; P = 0.03). No predictors were obtained regarding clinical worsening and occurrence of MALEs in our series. CONCLUSIONS: Patients with failure of endovascular procedures on FPOD appeared with clinical worsening in a no negligible number of cases in our sample regarding their preoperative clinical situation. Thus, we believe that endovascular treatment should be carefully deliberated.

Systematic nasogastric tube in aortic surgery: is it necessary?

BACKGROUND: Routine nasogastric tube (NGT) decompression has been traditionally used to prevent nausea and vomiting after abdominal surgery. Besides, many studies having demonstrated no benefits derived from this practice after an elective laparotomy, little evidence has been published regarding its use in aortic surgery. In this study, we analyze the effects of the selective use of the NGT in patients undergoing infrarenal aortic surgery in our center. METHODS: Prospective cohort study including patients who underwent elective infrarenal aortic surgery between January 2011 and December 2012. Patients were prospectively included in group A (systematic NGT placement) and group B (nonsystematic NGT). The main end point was the occurrence of postoperative nausea and vomiting (PONV). Secondary end points were postoperative complications, time to first oral intake, and hospital stay. RESULTS: One hundred patients were finally included in the study, 50 patients per group. Preoperative and intraoperative data were similar between both groups. Higher incidence of PONV (48% vs. 10%; relative risk, 2.4; 95% confidence interval [CI], 1.3-4.5; P = 0.003) was observed in group A. Selective NGT behaved as a protective factor regarding earlier first oral intake in first postoperative 48 hours (hazard ratio, 0.67; 95% CI, 0.45-0.99; P = 0.05). There were no differences in other adverse events although a trend toward fewer respiratory complications was observed in patients with nonsystematic NGT. CONCLUSIONS: This study demonstrates higher incidence of PONV and longer time to first oral intake in patients with systematic NGT with no benefits derived from this practice. Based on these results, selective NGT decompression should be encouraged in patients undergoing infrarenal aortic surgery.

Endovascular treatment of external iliac artery occlusive disease: midterm results.

PURPOSE: To report midterm outcomes for endovascular treatment of external iliac artery (EIA) occlusive disease and assess possible factors affecting patency. METHODS: A retrospective analysis was conducted of 99 consecutive patients (91 men; mean age 67.3 years) with claudication (n=70) or critical limb ischemia (n=29) owing to occlusive EIA disease treated at our center from January 2005 to June 2012. The majority of lesions (79/108) were TASC A/B. Lesions were a mean 42.2 mm long (range 10-125); 43/108 affected the distal third of the EIA. Balloon angioplasty alone was performed in 7 limbs, while the remaining 101 lesions were stented (65 self-expanding, 24 balloon-expandable, and 12 covered). Clinical and hemodynamic follow-up was performed at 1, 3, 6, and 12 months after therapy and yearly thereafter. The factors examined were procedure characteristics and patency rates. RESULTS: Over a median follow-up of 27.5 months (range 1-89), there were 2 (1.9%) early occlusions followed by a successful reintervention, 4 late occlusions, and 5 hemodynamic failures followed by 7 reinterventions. These events led to primary and secondary patency rates at 30 months of 89.7% and 94.1%, respectively. No differences in patency rates were detected according to age, clinical state, or comorbidity. Use of covered stents (p=0.006) was the only variable associated with lower primary patency rates. CONCLUSION: Endovascular therapy to treat TASC A/B lesions of the EIA yielded good short and midterm patency and low early morbidity and mortality. Lesions involving the distal third of the EIA treated by simple angioplasty ± stenting fared worse. No clinical factors could be correlated with patency.

Cystic adventitial degeneration of the popliteal artery: report on 3 cases and review of the literature.

BACKGROUND: Cystic adventitial disease (CAD) is a rare, nonatherosclerotic vascular condition predominantly seen in middle-aged men with no cardiovascular risk factors. Three cases have been diagnosed and treated in our institution during the past 8 years. The purpose of this report is to provide an updated literature review of this condition with the addition of 3 new cases. METHODS: Information about 3 new cases is presented along with data obtained from articles published between 1979 and 2012 from PubMed and Embase databases. Two hundred thirty-eight articles were found, and 98 were included in our review. RESULTS: All patients treated presented with rapidly progressive intermittent calf claudication. Diagnosis of CAD was confirmed by at least 2 imaging techniques, either duplex ultrasound or magnetic resonance imaging, with a preoperative angiography performed in all cases. Wall cyst resection was performed in the 3 cases reported here, after intraoperative confirmation that there was no arterial wall damage. All patients remained asymptomatic with no signs of recurrence after a median 36-month follow-up (24-60 month follow-up). CONCLUSIONS: CAD is a rare vascular condition usually affecting arteries that presents as a sudden onset of unilateral intermittent calf claudication. Diagnosis must be confirmed with imaging techniques, such as duplex ultrasonography and magnetic resonance imaging. On the basis of existing knowledge, surgery remains the treatment of choice, with cystic evacuation in cases with no arterial wall damage or resection and grafting. However, the follow-up algorithm for treated patients remains unclear.