Safety of preoperative branch embolization in patients undergoing evar.

The purpose of this systematic review is to evaluate the safety of pre-endovascular abdominal aortic aneurysm repair (EVAR) embolization of aortic side branches - the inferior mesenteric artery and lumbar arteries. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. A search of MEDLINE and DIMENSION databases identified 9 studies published from 2011 to 2021 that satisfied the inclusion and exclusion criteria. These studies were analyzed to detect the incidence of embolization-related complications. A total of 482 patients underwent preoperative aortic side branch embolization, 30 (6.2%) of whom suffered some kind of minor complication. The only major complication observed was ischemic colitis in 4 (0.82%) patients, two (0.41%) of whom died after bowel resection surgery. Regarding these findings, aortic side branch embolization seems to be a safe procedure, with very low percentages of both minor and major complications.

O objetivo desta revisão sistemática foi avaliar a segurança da embolização de artéria mesentérica inferior (AMI) e artérias lombares (ALs) pré-correção endovascular de aneurisma da aorta abdominal. Foram realizadas pesquisas nas bases de dados MEDLINE e Dimensions. Foram encontrados 9 estudos publicados de 2011 a 2021 que atendiam aos critérios de inclusão e exclusão. Os estudos foram analisados ​​para definir a incidência de complicações relacionadas à embolização. No total, 482 pacientes foram submetidos a embolização de AMI e/ou ALs, dos quais 30 (6,2%) sofreram algum tipo de complicação menor. A única complicação importante observada foi colite isquêmica em 4 (0,82%) pacientes. Dois (0,41%) desses pacientes morreram após cirurgia de ressecção intestinal. Em relação a esses achados, a embolização de AMI e ALs parece ser um procedimento seguro, com um percentual muito baixo de complicações menores e importantes.

Safety of preoperative branch embolization in patients undergoing evar / Segurança da embolização pré-operatória do ramo em pacientes submetidos a evar

Abstract The purpose of this systematic review is to evaluate the safety of pre-endovascular abdominal aortic aneurysm repair (EVAR) embolization of aortic side branches - the inferior mesenteric artery and lumbar arteries. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. A search of MEDLINE and DIMENSION databases identified 9 studies published from 2011 to 2021 that satisfied the inclusion and exclusion criteria. These studies were analyzed to detect the incidence of embolization-related complications. A total of 482 patients underwent preoperative aortic side branch embolization, 30 (6.2%) of whom suffered some kind of minor complication. The only major complication observed was ischemic colitis in 4 (0.82%) patients, two (0.41%) of whom died after bowel resection surgery. Regarding these findings, aortic side branch embolization seems to be a safe procedure, with very low percentages of both minor and major complications.

Resumo O objetivo desta revisão sistemática foi avaliar a segurança da embolização de artéria mesentérica inferior (AMI) e artérias lombares (ALs) pré-correção endovascular de aneurisma da aorta abdominal. Foram realizadas pesquisas nas bases de dados MEDLINE e Dimensions. Foram encontrados 9 estudos publicados de 2011 a 2021 que atendiam aos critérios de inclusão e exclusão. Os estudos foram analisados ​​para definir a incidência de complicações relacionadas à embolização. No total, 482 pacientes foram submetidos a embolização de AMI e/ou ALs, dos quais 30 (6,2%) sofreram algum tipo de complicação menor. A única complicação importante observada foi colite isquêmica em 4 (0,82%) pacientes. Dois (0,41%) desses pacientes morreram após cirurgia de ressecção intestinal. Em relação a esses achados, a embolização de AMI e ALs parece ser um procedimento seguro, com um percentual muito baixo de complicações menores e importantes.

Preoperative predictive factors for type II endoleak: Trying to define high-risk patients.

OBJECTIVE: Type 2 endoleaks (T2E) continue to be the "Achilles Heel" of endovascular aneurysm repair (EVAR). The aim of this study is to analyze preoperative factors of patients who underwent EVAR to define risk factors for T2E. METHODS: From January 2015 to June 2020, 140 of 191 patients who underwent EVAR in our institution meet inclusion criteria for this study. Postoperative image control were performed using duplex ultrasound or CT scan. All T2E detected during follow-up were confirmed by angio CT. Preoperative anatomic and clinical variables were analyzed for T2E using t-test, Mann-Whitney U test and Fisher exact test. ROC curves and the corresponding area under the curve (AUC) were used to describe the predictive accuracy for endoleak. RESULTS: T2E was detected in 16 patients (11.43%)0.12 of them (75%) were persistent and 10 (62.5%) provoked sac enlargement. Predictive factors for T2E were a greater IMA diameter (2.5 ± 0.5 vs. 3.3 ± 0.5, p < 0.001) and an increasing number of LA (4.8 ± 1.6 vs. 6.7 ± 1.4, p < 0.001). ROC curve analysis stablished thresholds of 3.5 mm for IMA diameter (sensitivity 77%, specificity 86%) and 5.5 for patent LA (sensitivity 88%, specificity 59%) as risk factor to develop T2E. CONCLUSIONS: Preoperative aortic side branches embolization to avoid T2E is not still standarised. We tried to define a group of high-risk patients for T2E. According to our findings, patients with a preoperative IMA> 3 mm and more than 5 patent LA should be considered for pre-EVAR embolization.

Symptomatic Aortic Arch Floating Thrombus In A Patient With "Bovine Arch".

Bovine arch is an aortic arch variant in which the left common carotid artery and the brachiocephalic trunk share the same origin. Several vascular pathologies, as aneurysm, dissection or strokes have an increased prevalence in patients with this anatomic variant. We describe the first reported case of a young patient with a symptomatic aortic arch floating thrombus in association with a bovine arch.

Actualización y algoritmos de toma de decisión en el manejo del aneurisma aórtico abdominal roto / Update and decision making algorithms on the management of ruptured abdominal aortic aneurysms

La rotura de un aneurisma aórtico abdominal (AAA) es un evento altamente letal que continúa asociada a una alta mortalidad, a pesar de su disminución en las últimas dos décadas, asociada a la adopción de la cirugía endovascular como primera línea de tratamiento y a avances en el manejo anestésico y perioperatorio. La actuación frente a un AAA roto (AAAr) puede dividirse en cuatro etapas: diagnóstico, manejo perioperatorio, cirugía y posoperatorio. En el marco de las guías americana y europea sobre manejo de AAAr y de la Guía NICE, se expone una actualización de los puntos críticos en cada etapa: desde el papel diagnóstico clave del angio-TAC hasta el manejo de complicaciones posoperatorias, como el síndrome compartimental abdominal. La creación de protocolos y algoritmos basada en la evidencia ayuda en la toma de decisiones y disminuye el tiempo desde el diagnóstico hasta el control hemorrágico, esencial para la supervivencia

A ruptured abdominal aortic aneurysm (rAAA) is a highly lethal event remaining associated with a high overall mortality, in spite of the reduction in the mortality from rAAA over the last two decades linked with the adoption of an endovascular aneurysm repair (EVAR) as the forefront strategy, as well as the advances in perioperative critical care practices. Management of a rAAA can be divided into four stages: diagnosis, perioperative management, surgical repair and postoperative period. Within the framework of American and European clinical practice guidelines on the management of abdominal aortic aneurysms and NICE guideline, all of them recently published, updated critical issues for each stage are shown. From the key role of CT angiogram for the diagnosis to the postoperative complications, such as abdominal compartment syndrome The creation of evidence-based protocols and algorithms for rapid diagnosis and treatment aids to make decisions and at the same time it will reduce the time since diagnosis to control of hemorrhage, which is essential for survival

Síndrome de Lemierre o tromboflebitis séptica de vena yugular interna tras extracción dentaria / Lemierre syndrome or septic thromboflebitis of internal yugular vein after dental extraction

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Misdiagnosed Malignant Tumor on an Ischemic Limb.

INTRODUCTION: Acral lentiginous melanoma (ALM) is a rare variety of melanoma typically located on distal areas of the body. Due to its presentation, it can be confused with a vascular ulcer. CASE REPORT: The authors present the case of a 68-year-old man who smokes with a history of hypertension, diabetes, and dyslipidemia, who was referred to the vascular clinic with complaints of intermittent claudication and a developing ulcer on his heel. After formulating an accurate wound care plan and performing revascularization surgery, the ulcer did not heal. At this point, the wound was biopsied and melanoma diagnosis was confirmed. After melanoma surgery, direct closure of the wound with a split-thickness skin graft was performed. CONCLUSIONS: Despite its rare pathology, misdiagnosis of ALM may prolong initiation of appropriate treatment and reduce the overall survival rate. Biopsies should be performed on nonhealing ulcers despite appropriate wound management and/or revascularization procedures.