Explantador de Cabrera: un nuevo dispositivo para explantar endoprótesis aórticas después de reparo endovascular de aneurisma de aorta, un estudio experimental ex vivo / Cabrera explanter: a new device to explant aortic stents after endovascular aortic aneurysm repair, an ex vivo experimental study

Introducción. Las complicaciones posteriores a la reparación endovascular de aneurisma (EVAR) pueden resolverse con técnicas endovasculares. Sin embargo, cuando está indicada, la explantación de una endoprótesis es un procedimiento complejo, que se asocia a lesiones vasculares o viscerales, con alta morbimortalidad, en pacientes con edad avanzada y múltiples comorbilidades, y por lo tanto, alto riesgo quirúrgico. No existen dispositivos producidos por la industria para explantar las endoprótesis aórticas, por lo que el objetivo de este trabajo fue desarrollar un dispositivo para la explantación de endoprótesis aórticas. Métodos. Se llevó a cabo un estudio experimental, en fase preclínica, para desarrollar un dispositivo para la explantación de endoprótesis aórticas, con pruebas en modelos 3D y en un modelo animal porcino cadavérico. Resultados. Es factible desarrollar un modelo experimental de un nuevo dispositivo para explantar endoprótesis aórticas, denominado explantador de Cabrera, y comprobar su funcionamiento en un modelo animal cadavérico. El uso del explantador de Cabrera limitó el daño de la pared aórtica por parte de la endoprótesis en un 100 % al momento de su explantación en un modelo experimental ex vivo. Conclusión. Usando una jeringa septo, el explantador de Cabrera es superior a la técnica estándar de explantación de una endoprótesis al limitar la lesión de la pared aórtica, al colapsar y liberar los ganchos de fijación suprarrenal de forma controlada y segura al interior de la luz aórtica y, posteriormente, extraerla de forma rápida y efectiva, conservando la mayor cantidad de aorta sana para la posterior reconstrucción aorto-ilíaca.

Introduction. Complications after endovascular aneurysm repair (EVAR) can be resolved with endovascular techniques; however, when indicated, stent explantation is a complex procedure, which is associated with vascular or visceral injuries, with high morbidity and mortality in patients, with advanced age and multiple comorbidities, and therefore high surgical risk. There are no devices produced by the industry to explant aortic endoprostheses, so the objective of this work was to develop a device for the explantation of aortic endoprostheses. Methods. An experimental study was carried out, in the preclinical phase, to develop a device for the explantation of aortic endoprostheses, with tests in 3D models and in a cadaveric porcine animal model. Results. It is feasible to develop an experimental model of a new device for explanting aortic endoprostheses, called Cabrera explanter, and verify its operation in a cadaveric animal model. The use of the Cabrera explanter limited damage to the aortic wall by the endoprosthesis by 100% at the time of explantation in an ex vivo experimental model. Conclusions. Using a septum syringe, the Cabrera explanter is superior to the standard stent explantation technique by limiting injury to the aortic wall, collapsing and releasing the adrenal fixation hooks in a controlled and safe manner into the aortic lumen, and subsequently, extract it quickly and effectively, preserving the greatest amount of healthy aorta for the subsequent aorto-iliac reconstruction.

Registro de actividades de la Sociedad Española de Angiología y Cirugía Vascular, año 2019 / Registry of activities of the Spanish Society of Angiology and Vascular Surgery, year 2019

Objetivo: describir la actividad asistencial del año 2019 de los servicios/unidades de angiología y cirugía vascular en España. Pacientes y métodos: estudio transversal con encuesta a 107 centros sobre procedimientos quirúrgicos y exploraciones vasculares realizados en 2019. Análisis descriptivo de resultados y comparación de la ratio de actividad /100 000 habitantes con 2018. Resultados: respondieron 44 servicios (41,1 %), 4 de ámbito privado. De los 42 servicios docentes, respondieron 29 (65,9 %), un 65,9 %. En los servicios que respondieron se produjeron 26 960 ingresos, el 46,4 % urgentes y el 53,5 % programados (estancia media: 6,8 días). En la mayoría de sectores no hubo cambios significativos en la ratio/100 000 habitantes, salvo un aumento moderado (10,7 frente a 9,4) en el sector distal, tanto en procedimientos quirúrgicos (3,3 frente a 2,8) como en endovasculares (7,3 frente a 6,6). Descenso moderado de procedimientos endovasculares en los troncos supraaórticos (1,4 frente a 1,6). Hubo una disminución moderada de procedimientos quirúrgicos en aorta torácica (0,17 frente a 0,20) y abdominal (2,38 frente a 2,78), que contrastó con un aumento moderado en procedimientos endovasculares abdominotorácicos (0,40 frente a 0,35). En las arterias viscerales se encontró una disminución relevante de procedimientos endovasculares (0,89 frente a 1,16) y un aumento moderado de los quirúrgicos (0,99 frente a 0,89). En el sector aortoilíaco hubo un aumento moderado de procedimientos endovasculares (6,8 frente a 5,8). En 2019 también se encontró una disminución relevante en el número de procedimientos endovasculares relacionados con los accesos de hemodiálisis (1,2 frente a 1,5), un descenso moderado en el número de amputaciones mayores (6,9 frente a 7,8) y un descenso relevante de actividad sobre las malformaciones (0,32 frente a 0,59). Se encontró un aumento moderado en la actividad global sobre el sector venoso con respecto a la de 2018 (93,3 vs. 80,3)...(AU)

Introduction and objective: to describe the healthcare activity of the Angiology and Vascular Surgery services/units in Spain in 2019.Patients and methods: cross-sectional study with a survey of 107 centers on surgical procedures and vascularexplorations performed in 2019. Descriptive analysis of results and comparison of the activity ratio / 100,000inhabitants with 2018.Results: 44 services responded (41.1 %), with only 4 being private. Of the 42 teaching services, 29 (65.9 %) respon-ded, representing 65.9 % of the total. In the services that responded, there were 26,960 admissions, 46.4 % urgentand 53.5% scheduled, with an average stay of 6.8 days. Global surgical activity in arterial surgery in 2019 was similarto that of 2018. In most sectors there were no significant changes in the ratio / 100,000 inhabitants, except for amoderate increase (10.7 vs. 9.4) in the distal sector , finding the increase in both surgical procedures (3.3 vs. 2.8) andendovascular procedures (7.3 vs. 6.6). Furthermore, a moderate decrease in endovascular procedures was foundin the supra-aortic trunks (1.4 vs. 1.6). There was a moderate decrease in surgical procedures in the thoracic aorta(0.17 vs. 0.20) and abdominal (2.38 vs. 2.78), which contrasted with a moderate increase in thoraco-abdominalendovascular procedures (0.40 vs. to 0.35). In visceral arteries, a relevant decrease in endovascular procedures wasfound (0.89 vs. 1.16) and a moderate increase in surgical procedures (0.99 vs. 0.89). In the aorto-iliac sector therewas a moderate increase in endovascular procedures (6.8 vs. 5.8). In 2019, a relevant decrease was also found inthe number of endovascular procedures related to hemodialysis accesses (1.2 vs. 1.5), and a moderate decreasein the number of major amputations (6.9 vs. 7.8)...(AU)

Umbral crítico de administración en pacientes con trauma severo y reanimación endovascular: ¿Un concepto útil? / Critical Administration Threshold in severe trauma patients and endovascular resuscitation: A useful concept?

Introducción. Se describe la utilidad del umbral crítico de administración (CAT por su denominación en inglés) como herramienta para la reanimación hemostática en pacientes con trauma severo y oclusión endovascular aórtica. Métodos. Revisión retrospectiva de pacientes adultos con hemorragia por trauma, con o sin oclusión endovascular aórtica (REBOA), atendidos entre enero de 2015 y junio de 2020, en un centro de trauma nivel I en Cali, Colombia. Se registraron variables demográficas, severidad del trauma, estado clínico, requerimiento transfusional, tiempo hasta CAT+ y CAT alcanzado (1, 2 ó 3). Resultados. Se incluyeron 93 pacientes, se utilizó REBOA en 36 y manejo tradicional en 57. El grupo REBOA presentó mayor volumen de sangrado (mediana de 3000 ml, RIC: 1950-3625 ml) frente al grupo control (mediana de1500 ml, RIC: 700-2975ml) (p<0,001) y mayor cantidad de glóbulos rojos transfundidos en las primeras 6 horas (mediana de 5, RIC:4-9); p=0,015 y en las primeras 24 horas (mediana de 6, RIC: 4-11); p=0,005. No hubo diferencias estadísticamente significativas en número de pacientes CAT+ entre grupos o tiempo hasta alcanzarlo. Sin embargo, el estado CAT+ durante los primeros 30 minutos de la cirugía fue mayor en grupo REBOA (24/36, 66,7 %) frente al grupo control (17/57, 29,8 %; p=0,001), teniendo este mayor tasa de mortalidad intrahospitalaria frente a los pacientes CAT-. Conclusión. El umbral crítico de administración es una herramienta útil en la reanimación hemostática de pacientes con trauma y REBOA, que podría predecir mortalidad precoz.

Introduction. The objective is to describe the utility of the Critical Administration Threshold (CAT) as a tool in hemostatic resuscitation in patients with severe trauma and REBOA. Methods. Retrospective review between January 2015 and June 2020 of adult patients with hemorrhage secondary to trauma with or without REBOA in a level I trauma center in Cali, Colombia. Demographic variables, trauma severity, clinical status, transfusion needs, time to CAT+ and number of CAT achieved (1, 2 or 3) were recorded. Results. Ninety-three patients were included, in which REBOA was used in 36 and traditional management in 57. The REBOA group had a higher bleeding volume (3000 ml), IQR: 1950-3625 ml vs the control group (1500 ml, IQR: 700-2975 ml) (p<0.001) and a higher rate of PRBC units transfused in the first 6 hours (median 5, IQR: 4-9); p=0.015 and in the first 24 hours (median 6, IQR: 4-11); p=0.005. There were no statistically significant differences in the number of CAT+ patients between groups or time to CAT+. However, CAT+ status during the first 30 minutes of surgery was higher in the REBOA Group (24/36, 66.7%) vs. the control group (17/57, 29.8%; p=0.001), having this group a higher in-hospital mortality rate vs. CAT- patients. Conclusion. CAT is a useful tool in the hemostatic resuscitation of patients with trauma and REBOA that could predict early mortality.

Evaluation of the relationship between computed tomography angiography collateral scores and clinical outcome / Avaliação da relação entre escores colaterais da angiotomografia computadorizada e evolução clínica

Abstract Background The relationship between collateral circulation and prognosis after endovascular treatment in anterior circulation strokes has been reported in many studies. Objective In this study, we aimed to compare the predictive power of clinical outcome by comparing five different collateral scores that are frequently used. Methods Among the patients who underwent endovascular treatment in our clinic between November 2019 and December 2021, patients with premorbid mRS < 3, intracranial ICA and/or MCA M1 occlusion, and a pre-procedural multiphase CTA examination were included in the study. Demographic, technical, and duration information about the procedure, major events after the procedure, and clinical outcomes at 3 months were recorded. The mCTA, Tan, Maas, Miteff, and rLMC collateral scores of the patients were evaluated. Results Clinical outcome at 3 months were good in 37 of the 68 patients included in the study (mRS ≤ 2). Only the mCTA and rLMC collateral scores were statistically significantly higher in those with a good clinical outcome. Significant correlation with 3-month mRS was detected only in mCTA and rLMC scores. Although rLMC and mCTA collateral scores showed a statistically significant association with prognosis, they were not sufficient to be an independent predictor of prognosis. Conclusion mCTA and rLMC were found to have the highest predictive power of clinical outcome and the highest correlation with the 3-month clinical outcome. Our study suggests that it would be beneficial to develop a new scoring system over multiphase CTA, which combines regional and temporal evaluation, which are the strengths of both collateral scoring.

Resumo Antecedentes A relação entre circulação colateral e prognóstico após tratamento endovascular em acidentes vasculares cerebrais de circulação anterior tem sido relatada em muitos estudos. Objetivo Neste estudo, nosso objetivo foi comparar o poder preditivo do desfecho clínico comparando cinco escores colaterais diferentes que são frequentemente utilizados. Métodos Entre os pacientes submetidos a tratamento endovascular em nossa clínica entre novembro de 2019 e dezembro de 2021, foram incluídos no estudo pacientes com mRS pré-mórbido < 3, oclusão intracraniana de ICA e/ou MCA M1 e exame de CTA multifásico pré-procedimento. Foram registradas informações demográficas, técnicas e de duração sobre o procedimento, eventos importantes após o procedimento e resultados clínicos em três meses. Foram avaliados os escores colaterais mCTA, Tan, Maas, Miteff e rLMC dos pacientes. Resultados Os resultados clínicos aos três meses foram bons em 37 dos 68 pacientes incluídos no estudo (mRS ≤ 2). Apenas os escores colaterais mCTA e rLMC foram estatisticamente significativamente maiores naqueles com boa evolução clínica. Correlação significativa com mRS de três meses foi detectada apenas nos escores mCTA e rLMC. Embora os escores colaterais de rLMC e mCTA tenham mostrado uma associação estatisticamente significativa com o prognóstico, eles não foram suficientes para serem um preditor independente de prognóstico. Conclusão Verificou-se que mCTA e rLMC têm o maior poder preditivo do resultado clínico e a maior correlação com o resultado clínico de três meses. Nosso estudo sugere que seria benéfico desenvolver um novo sistema de pontuação em vez de CTA multifásico, que combinasse avaliação regional e temporal, que são os pontos fortes de ambas as pontuações colaterais.

Alopecia temporária após tratamento endovascular relacionada a uma malformação arteriovenosa em face: relato de caso / Temporary alopecia after endovascular treatment related to an arteriovenous malformation in the face: case report / Alopecia temporal posterior a tratamiento endovascular relacionado con malformación arteriovenosa en la cara: reporte de caso

Objetivo: relatar um caso de alopecia temporária após tratamento endovascular com exposição por fluoroscopia devido a uma malformação arteriovenosa na face. Detalhamento do caso: sexo masculino, 34 anos, com queixa de lesão na asa nasal, lábio superior e lateral da face (direita). O paciente trouxe exame de angioressonância apresentando uma malformação arteriovenosa em face com nutrição pela artéria facial e drenagem pela veia mandibular. Como tratamento foi optado uma arteriografia diagnóstica para melhor avaliação de vascularização da malformação arteriovenosa seguida de embolização com onyx® (mistura de etileno vinil álcool copolímero) que fornece o contraste necessário para a visibilização da mistura sob fluoroscopia. O procedimento foi realizado 14 dias após a 1ª consulta, sem intercorrências indicando sucesso terapêutico. No retorno, terceira semana após o procedimento, apresentou alopecia setorial em região occipitoparietal direita. Não havia manchas em região, bem como outros sintomas associados. Foi realizado como tratamento o uso de Minoxidil tópico e Cilostazol via oral. Após o tratamento houve retorno do crescimento espontâneo em cerca de 2 meses. Considerações finais: a embolização com onyx® mostrou-se uma valiosa opção terapêutica com uma maior conservação das estruturas nobres em malformações arteriovenosas, com baixa taxa de complicações no médio e longo prazo.

Objective: to report a case of temporary alopecia after endovascular treatment with fluoroscopy exposure due to an arteriovenous malformation on the face. Case detail: male, 34 years old, complaining of a lesion on the nasal wing, upper lip and side of the face (right). The patient brought an angioresonance exam showing an arteriovenous malformation in the face with nutrition through the facial artery and drainage through the mandibular vein. As a treatment, a diagnostic arteriography was chosen for a better assessment of the vascularity of the arteriovenous malformation followed by embolization with onyx® (mixture of ethylene vinyl alcohol copolymer), which provides the necessary contrast for visualization of the mixture under fluoroscopy. The procedure was performed 14 days after the 1st consultation, with no intercurrences indicating therapeutic success. On return, third week after the procedure, he presented sectoral alopecia in the right occipitoparietal region. There were no stains in the region, as well as other associated symptoms. The use of topical Minoxidil and oral Cilostazol was carried out as treatment. After treatment there was a return of spontaneous growth in about 2 months. Final considerations: embolization with onyx® proved to be a valuable therapeutic option with greater conservation of noble structures in arteriovenous malformations, with a low rate of complications in the medium and long term.

Objetivo: reportar un caso de alopecia transitoria posterior a tratamiento endovascular con exposición radioscópica debido a una malformación arteriovenosa en la cara. Detalle del caso: varón, 34 años, que se queja de una lesión en el ala nasal, labio superior y lado de la cara (derecha). El paciente trajo un examen de angiorresonancia que mostró una malformación arteriovenosa en la cara con nutrición a través de la arteria facial y drenaje a través de la vena mandibular. Como tratamiento se optó por una arteriografía diagnóstica para una mejor valoración de la vascularización de la malformación arteriovenosa seguida de embolización con onyx® (mezcla de copolímero de etileno alcohol vinílico), que proporciona el contraste necesario para la visualización de la mezcla bajo fluoroscopia. El procedimiento se realizó 14 días después de la 1.ª consulta, sin intercurrencias que indicaran éxito terapéutico. A su regreso, a la tercera semana del procedimiento, presenta alopecia sectorial en región occipitoparietal derecha. No había manchas en la región, así como otros síntomas asociados. Como tratamiento se realizó el uso de Minoxidil tópico y Cilostazol oral. Después del tratamiento hubo un retorno del crecimiento espontáneo en aproximadamente 2 meses. Consideraciones finales: la embolización con onyx® demostró ser una valiosa opción terapéutica con mayor conservación de las estructuras nobles en las malformaciones arteriovenosas, con una baja tasa de complicaciones a medio y largo plazo.

Tratamientos agudos de recanalización en el ictus arterial isquémico pediátrico posnatal. Código ictus pediátrico / Acute recanalization treatments in postnatal paediatric ischaemic arterial strole. Paediatric stroke code

El ictus arterial isquémico infantil es una patología mucho menos conocida que en adultos debido a su menor frecuencia y a su diferente etiología. Sin embargo, es también una patología grave con una alta incidencia de secuelas severas y perennes, que sobrepasan el 50% de los casos. El manejo agudo del ictus arterial isquémico pediátrico posnatal (IAIPP) ha cambiado drásticamente en los últimos años, fundamentalmente en lo referente a los tratamientos de recanalización (trombólisis y terapias endovasculares). Estos tratamientos, que antes no se recomendaban en la edad infantil, se están afianzando cada vez más en la práctica diaria. Aunque los estudios realizados en niños no tienen un grado de evidencia alto por ser retrospectivos y porque el número de casos es bajo, soportan la idea de que dichos tratamientos son igual de seguros y eficaces que en los adultos siempre que se realicen con unos criterios de inclusión y exclusión determinados y dentro de un tiempo determinado desde el inicio de los síntomas (ventana terapéutica). En este artículo se revisa, a la luz de los conocimientos actuales, el manejo agudo del IAIPP. Debido a que la eficacia de estos tratamientos está íntimamente ligada al inicio precoz de los mismos, es necesaria la existencia de un código ictus infantil como ampliación del código ictus que se aplica a los adultos. Ha empezado a implantarse en España desde el año 2019 aunque todavía hay importantes zonas del país donde aún no se aplica. (AU)

In children, arterial ischemic stroke is a much less understood disease compared to in adults due to its lower frequency and different aetiology. However, it is also a serious disease, with a high incidence of severe and permanent sequelae that exceeds 50% of total cases. The acute management of postnatal arterial ischaemic stroke (MNAIS) has changed drastically in recent years, chiefly on account of recanalization treatments (thrombolysis and endovascular therapies). These treatments, which used to not be recommended in childhood, are increasingly implemented in everyday clinical practice. Although the evidence from studies carried out in children is not of high quality due to their retrospective design and the small number of reported cases, they support the hypothesis that these treatments are as safe and effective as they are in adults as long as appropriate eligibility criteria are applied and they are used within a certain time from the onset of symptoms (therapeutic window). This article reviews the MNAIS based on the current scientific evidence. Since the efficacy of these treatments is highly dependent on their early initiation, a paediatric stroke code needs to be in place as an extension of the stroke code applied to adults. It has started to be introduced in Spain since 2019, although there are still large areas of the country where it has yet to be applied. (AU)

Acute recanalization treatments in postnatal paediatric ischaemic arterial stroke. Paediatric stroke code.

In children, arterial ischemic stroke is a much less understood disease compared to in adults due to its lower frequency and different aetiology. However, it is also a serious disease, with a high incidence of severe and permanent sequelae that exceeds 50% of total cases. The acute management of postnatal arterial ischaemic stroke (MNAIS) has changed drastically in recent years, chiefly on account of recanalization treatments (thrombolysis and endovascular therapies). These treatments, which used to not be recommended in childhood, are increasingly implemented in everyday clinical practice. Although the evidence from studies carried out in children is not of high quality due to their retrospective design and the small number of reported cases, they support the hypothesis that these treatments are as safe and effective as they are in adults as long as appropriate eligibility criteria are applied and they are used within a certain time from the onset of symptoms (therapeutic window). This article reviews the MNAIS based on the current scientific evidence. Since the efficacy of these treatments is highly dependent on their early initiation, a paediatric stroke code needs to be in place as an extension of the stroke code applied to adults. It has started to be introduced in Spain since 2019, although there are still large areas of the country where it has yet to be applied.

Difficult withdrawal of an inferior vena cava filter: Technical considerations and associated variables.

OBJECTIVE: To analyse the efficacy of the procedure for withdrawing an inferior vena cava (IVC) filter and the clinical and radiological factors associated with difficult withdrawal. MATERIAL AND METHODS: This retrospective observational study included patients who underwent IVC filter withdrawal at a single centre between May 2015 and May 2021. We recorded demographic, clinical, procedural, and radiological variables: type of IVC filter, angle with the IVC > 15°, hook against the wall, and legs embedded in the IVC wall > 3 mm. The efficacy variables were fluoroscopy time, success of IVC filter withdrawal, and number of attempts to withdraw the filter. The safety variables were complications, surgical removal, and mortality. The main variable was difficult withdrawal, defined as more than 5 min fluoroscopy or more than 1 attempt at withdrawal. RESULTS: A total of 109 patients were included; withdrawal was considered difficult in 54 (49.5%). Three radiological variables were more common in the difficult withdrawal group: hook against the wall (33.3% vs. 9.1%; p = 0.027), embedded legs (20.4% vs. 3.6%; p = 0.008), and >45 days since IVC filter placement (51.9% vs. 25.5%; p = 0.006). These variables remained significant in the subgroup of patients with OptEase IVC filters; however, in the group of patients with Celect IVC filters, only the inclination of the IVC filter >15 ° was significantly associated with difficult withdrawal (25% vs 0%; p = 0.029). CONCLUSION: Difficult withdrawal was associated with time from IVC placement, embedded legs, and contact between the hook and the wall. The analysis of the subgroups of patients with different types of IVC filters found that these variables remained significant in those with OptEase filters; however, in those with cone-shaped devices (Celect), the inclination of the IVC filter >15° was significantly associated with difficult withdrawal.

Retirada difícil de filtro de vena cava inferior (FVCI). Consideraciones técnicas y variables asociadas / Difficult withdrawal of an inferior vena cava filter: technical considerations and associated variables

Objetivo: Analizar la eficacia del procedimiento de retirada de los filtros de la vena cava inferior (FVCI), así como los factores clínico-radiológicos asociados a una retirada difícil. Material y método: Estudio retrospectivo, observacional y unicéntrico de pacientes tratados mediante retirada de FVCI entre mayo del 2015 y mayo del 2021. Se recogieron variables clínico-demográficas, del procedimiento y radiológicas: tipo de FVCI, angulación respecto a la vena cava inferior (VCI) >15°, gancho contra la pared y patas del dispositivo incrustadas en la pared de VCI> 3mm. Las variables de eficacia fueron: tiempo de fluoroscopia, éxito en la retirada del FVCI y número de intentos hasta la retirada. Como variables de seguridad: presencia de complicaciones, retirada quirúrgica y mortalidad. La variable principal fue la retirada difícil, definida como más de 5min de fluoroscopia o más de un intento de retirada. Resultados: Se incluyó a 109 pacientes, 54 (49,5%) fueron considerados retirada difícil. Las variables radiológicas gancho contra la pared (33,3% vs. 9,1%; p=0,027), patas incrustadas (20,4% vs. 3,6%; p=0,008) y> 45 días desde la colocación (51,9% vs. 25,5%; p=0,006) fueron significativamente más frecuentes en el grupo de retirada difícil. Estas variables mantienen la asociación al analizar los FVCI Optease®. En los FVCI Celect® solo se asoció con retirada difícil la inclinación del FVCI> 15° (25% vs. 0%; p=0,029).Conclusión: Se ha encontrado asociación entre una retirada difícil y las siguientes variables: tiempo desde colocación del FVCI, patas incrustadas y contacto del gancho con la pared de VCI. Al analizar según el tipo de FVCI, estas variables se mantienen en el tipo Optease®, en cambio, la inclinación de más de 15° dificulta la retirada de los dispositivos de morfología cónica (Celect®).(AU)

Objective: To analyze the efficacy of the procedure for withdrawing an inferior vena cava (IVC) filter and the clinical and radiological factors associated with difficult withdrawal. Material and methods: This retrospective observational study included patients who underwent IVC filter withdrawal at a single center between May 2015 and May 2021. We recorded demographic, clinical, procedural, and radiological variables: type of IVC filter, angle with the IVC> 15°, hook against the wall, and legs embedded in the IVC wall> 3mm. The efficacy variables were fluoroscopy time, success of IVC filter withdrawal, and number of attempts to withdraw the filter. The safety variables were complications, surgical removal, and mortality. The main variable was difficult withdrawal, defined as more than 5minutes fluoroscopy or more than 1 attempt at withdrawal. Results: A total of 109 patients were included; withdrawal was considered difficult in 54 (49.5%). Three radiological variables were more common in the difficult withdrawal group: hook against the wall (33.3% vs. 9.1%; p=0.027), embedded legs (20.4% vs. 3.6%; p=0.008), and>45 days since IVC filter placement (51.9% vs. 25.5%; p=0.006). These variables remained significant in the subgroup of patients with OptEase IVC filters; however, in the group of patients with Celect IVC filters, only the inclination of the IVC filter>15° was significantly associated with difficult withdrawal (25% vs 0%; p=0.029). Conclusion: Difficult withdrawal was associated with time from IVC placement, embedded legs, and contact between the hook and the wall. The analysis of the subgroups of patients with different types of IVC filters found that these variables remained significant in those with OptEase filters; however, in those with cone-shaped devices (Celect), the inclination of the IVC filter>15° was significantly associated with difficult withdrawal.(AU)

Embolización de aneurismas intracraneales múltiples en sesión única

Objetivo: Determinar los resultados clínicos y angiográficos en pacientes con aneurismas intracraneales múltiples tratados endovascularmente en una única sesión. Materiales y Métodos: Se incluyó a todos los pacientes mayores de 18 años con aneurismas múltiples (≥2), rotos o no rotos, tratados con terapia endovascular en una única sesión entre 2019 y 2021. Se recolectaron los datos clínicos y angiográficos. Se determinó la tasa de oclusión inmediata y del seguimiento. La escala de Rankin modificado se usó para valorar el resultado clínico. Resultados: Se trataron 25 pacientes, de los cuales 14 se presentaron con hemorragia subaracnoidea. Se diagnosticaron un total de 78 aneurismas, de los cuales 59 aneurismas fueron tratados. La localización más frecuente fue el segmento oftálmico. La altura máxima promedio fue de 5.2mm, lo cual tuvo diferencia estadística significativa con el estado de ruptura (p ≤ 0.02). El principal tipo de tratamiento endovascular fue la técnica de remodeling en el 39 % de casos. El Raymond Roy inmediato fue I en el 60 % y IIIa en el 35 % de casos. La tasa de complicaciones fue del 24 % y de mortalidad fue del 8 %. Conclusiones: El tratamiento endovascular en una única sesión es una opción efectiva y segura en casos de aneurismas intracraneales múltiples en nuestra institución con tasa de oclusión y complicaciones aceptable.

Objective: To determine clinical and angiographical outcomes in patients with multiple intracranial aneurysms who underwent endovascular therapy in a single session. Materials and Methods: Patients older than 18 years with multiple (≥2) ruptured or non-ruptured aneurysms were included, and all of them underwent endovascular therapy in a single session between 2019 and 2021. Clinical and angiographic data was collected. Immediate occlusion and follow-up data were collected. Rankin modified scale was used for assessing clinical outcomes. Results: Twenty-five patients were treated, and fourteen had subarachnoid hemorrhage. Seventy-eight aneurysms were diagnosed, and 59 of them were treated. The most frequent location was at the ophthalmic segment. Maximum average height was 5.2- mm, which showed significant statistical difference with a ruptured condition (p≤0.02). The main modality for endovascular therapy was the remodeling technique, which was used in 39% of all cases. Immediate Raymond Roy staging was I in 60% of all cases, and IIIa in 35% of all cases. Complication rate was 24%, and mortality rate was 8%. Conclusions: Single session endovascular therapy is an effective and safe option for cases of multiple intracranial aneurysms in our institution. Occlusion and complication rates were acceptable.

A novel balloon-assisted technique to secure visceral catheterization during a chimney endovascular repair of a ruptured abdominal aortic aneurysm in a centenarian patient / Uma nova técnica assistida por balão para assegurar a cateterização visceral durante o reparo endovascular, com a técnica de chaminé, de um aneurisma de aorta roto em um paciente centenário

Abstract A 100-year-old male patient was admitted with a ruptured abdominal aortic aneurysm due to type IA endoleak. Given the proximity of the ruptured site to the superior mesenteric artery (SMA) and renal arteries, a ChEVAR was indicated. Catheterization of the target visceral vessels was a challenging procedural step because of an intensely tortuous thoracic aorta. This hostile aortic anatomy also inhibited exchange for a super stiff guide-wire and selective cannulation with the diagnostic catheter was repeatedly lost when guidewire exchange was attempted. To overcome this issue, a 5 x 40 mm balloon catheter was placed 3cm into the target arteries. The balloon was then inflated below the nominal pressure limit enabling safe exchange for a super stiff guidewire and placement of three 90-cm long 7Fr guiding sheaths. The procedure was thus safely performed with deployment of an aortic extension and the bridging stents.

Resumo Um paciente de 100 anos foi diagnosticado com um aneurisma de aorta abdominal roto por um endoleak 1A. Pela proximidade do ponto de ruptura com a artéria mesentérica superior (AMS) e as artérias renais, um ChEVAR foi indicado. A cateterização das artérias-alvo foi um passo desafiador pela intensa tortuosidade da aorta torácica. Essa anatomia aórtica hostil também impediu a troca por um fio-guia extra-rígido, e a cateterização seletiva foi repetidamente perdida quando a troca de fio-guia foi tentada. Para superar essa dificuldade, um cateter balão 5mm x 40mm foi posicionado nas artérias-alvo. O balão foi, então, insuflado abaixo da pressão nominal, permitindo uma troca segura do fio-guia por um fio-guia extra-rígido e o posicionamento de três bainhas longas 7Frx 90cm. Assim, o procedimento foi executado de forma segura, com o implante de uma extensão aórtica e dos stents recobertos.

Brazilian Society for Angiology and Vascular Surgery guidelines on abdominal aortic aneurysm / Projeto Diretrizes, Sociedade Brasileira de Angiologia e Cirurgia Vascular: aneurisma da aorta abdominal

Abstract The Brazilian Society of Angiology and Vascular Surgery, through the Guidelines Project, presents new Abdominal Aortic Aneurysm Guidelines, on the subject of care for abdominal aortic aneurysm patients. Its development prioritized descriptive guidelines, using the EMBASE, LILACS, and PubMed databases. References include randomized controlled trials, systematic reviews, meta-analyses, and cohort studies. Quality of evidence was evaluated by a pair of coordinators, aided by the RoB 2 Cochrane tool and the Newcastle Ottawa Scale forms. The subjects include juxtarenal aneurysms, infected aneurysms, and new therapeutic techniques, especially endovascular procedures. The current version of the guidelines include important recommendations for the primary topics involving diagnosis, treatment, and follow-up for abdominal aortic aneurysm patients, providing an objective guide for medical practice, based on scientific evidence and widely available throughout Brazil.

Resumo A Sociedade Brasileira de Angiologia e Cirurgia Vascular, por meio do projeto Diretrizes, apresenta as novas Diretrizes de Aorta Abdominal, referentes aos cuidados de pacientes com aneurisma de aorta abdominal. Para sua elaboração, foram priorizadas diretrizes descritivas, utilizando as bases EMBASE, LILACS e PubMed. As referências incluem ensaios clínicos randomizados, revisões sistemáticas, metanálises e estudos de coorte. A qualidade das evidências foi examinada por uma dupla de coordenadores, com auxílio da ferramenta RoB 2 da Colaboração Cochrane e dos formulários da Newcastle Ottawa Scale. Aneurismas justarrenais, infectados e novas técnicas terapêuticas, principalmente no âmbito endovascular, estão entre os temas estudados. A versão atual das Diretrizes apresenta importantes recomendações para os principais itens que envolvem o diagnóstico, tratamento e acompanhamento de pacientes com aneurisma de aorta abdominal, oferecendo um guia objetivo para prática médica, construído a partir de evidências científicas e amplamente acessível em todo o território nacional.

Fístula aorto-esofágica primária: relato de caso / Primary aortoesophageal fistula: case report

Resumo Fístula aorto-esofágica é uma comunicação anormal entre a aorta e o esôfago, causadora de hemorragia digestiva alta potencialmente fatal. O objetivo deste trabalho é relatar um caso de sucesso na abordagem endovascular aórtica única e tratamento conservador do esôfago em fistula aorto-esofágica. A paciente de 81 anos foi admitida com sinais de hemorragia digestiva alta volumosa e, após realização de exames, diagnosticou-se uma fístula aorto-esofágica. Optado pela realização de tratamento endovascular, sendo bem sucedido, a paciente recebeu alta após nove dias de internação e manteve-se em seguimento ambulatorial até a resolução total do quadro. O diagnóstico precoce é extremamente importante, uma vez que se trata de uma patologia fatal na ausência de tratamento. Espera-se agregar conteúdo pertinente para comunidade científica.

Abstract An aortoesophageal fistula is an abnormal communication between the aorta and the esophagus, causing potentially fatal upper gastrointestinal bleeding. The objective of this article is to report a successful case of treatment with a single aortic endovascular approach and conservative treatment of the esophagus in a case of aortoesophageal fistula. An 81-year-old patient was admitted with signs of massive upper gastrointestinal bleeding and, after tests, an aortoesophageal fistula was diagnosed. Endovascular treatment was chosen and performed successfully. The patient was discharged after 9 days in hospital and remained in outpatient follow-up until the condition completely resolved. Early diagnosis is extremely important, since this is a fatal condition if left untreated. It is hoped that this report contributes content of relevance to the scientific community.

Gastrite isquêmica grave por isquemia mesentérica crônica / Severe ischemic gastritis caused by chronic mesenteric ischemia

Resumo A gastrite isquêmica é uma doença rara, podendo ocorrer por insuficiência vascular focal ou sistêmica. Essa condição é raramente vista na prática médica devido à vasta rede colateral arterial do estômago pelo tronco celíaco e mesentérica superior. A apresentação clássica da isquemia crônica é formada pela tríade de dor pós-prandial, perda de peso e sopro abdominal. A intervenção está indicada naqueles pacientes sintomáticos, sendo o tratamento endovascular uma alternativa à cirurgia em pacientes com alta comorbidade, tendo bons resultados. Reportamos um caso de gastrite isquêmica grave com úlceras e sangramento que foi causado por isquemia mesentérica crônica, em uma paciente de 71 anos, com oclusão do tronco celíaco e mesentérica inferior, além de estenose crítica da superior. O diagnóstico foi confirmado por exame de imagem, e a paciente foi submetida a tratamento endovascular. Trata-se de uma condição rara de diagnóstico e tratamento desafiadores, a qual requer uma equipe multidisciplinar para o manejo adequado.

Abstract Ischemic gastritis is a rare illness caused by localized or systemic vascular insufficiency. This condition is rarely seen in medical practice due to the vast arterial collateral blood supply to the stomach through the celiac trunk and superior mesenteric artery and also because other etiologies are much more frequent. The classic presentation of chronic ischemia is comprises the triad of postprandial pain, weight loss, and abdominal bruit. Intervention is indicated in symptomatic patients and endovascular treatment is an alternative to surgery in patients with high comorbidity that offers good results. We report a case of a 71-year-old female patient with severe ischemic gastritis with ulcers and bleeding caused by chronic mesenteric ischemia with occlusion of the celiac trunk and inferior mesenteric artery and critical stenosis of the superior mesenteric artery. The diagnosis was confirmed by imaging, and the patient underwent endovascular treatment. This is a rare condition that is difficult to diagnose and treat and a multidisciplinary team is needed for proper management.

Tratamento endovascular de aneurisma de artéria isquiática bilateral com stent recoberto autoexpansível Covera® - relato de caso / Endovascular repair of bilateral sciatic artery aneurysm with Covera® self expandable covered stents - case report

Resumo A persistência da artéria isquiática é um remanescente embriológico da artéria ilíaca interna que ocorre em 0,03% a 0,06% da população, podendo evoluir com degeneração aneurismática. A presença do aneurisma pode levar a embolização, com aumento de risco de perda do membro, principalmente se a artéria isquiática for seu principal suprimento arterial. O tratamento do aneurisma de artéria isquiática está indicado sempre que diagnosticado, devido ao alto risco de complicações. Entre as opções de tratamento, estão o tratamento aberto convencional, o tratamento endovascular e o tratamento híbrido. No presente estudo, será descrito o caso de um paciente apresentando persistência completa das artérias isquiáticas bilateralmente, com degeneração aneurismática de ambas, corrigida de forma endovascular com stent recoberto Covera® (Bard Medical, Geórgia, Estados Unidos).

Abstract A persistent sciatic artery is an embryological remnant of the internal iliac artery that occurs in 0.03% to 0.06% of the population and may develop aneurysmal degeneration. Aneurysms can lead to distal embolization with increased risk of limb loss, especially if the sciatic artery is the main arterial supply to the limb. A sciatic artery aneurysm must be treated whenever diagnosed, because of the high risk of complications. Treatment options include open, endovascular, or hybrid repair. This manuscript describes a patient with bilateral persistence of the sciatic arteries, both with aneurysmal degeneration, who underwent endovascular repair with Covera® (Bard Medical, Georgia-USA) covered stents.

Big data analysis of endovascular treatment of intracranial aneurysms: a bibliometric analysis of the top 100 most cited articles / Análise de grandes dados do tratamento endovascular de aneurismas intracranianos: uma análise bibliométrica dos 100 artigos mais citados

Abstract Background The impact of a literature report on a particular subject can be measured by its number of citations. Objective The purpose of this study was to evaluate the characteristics of the literature reports in the field of endovascular treatment of intracranial aneurysms (IAs) by analyzing the top 100 most cited articles. It should be noted that the focus of this study is to describe the bibliometric characteristics. Methods This bibliometric analysis dedicated only to endovascular treatment of IAs in our study. We searched the top 100 most cited articles in the field of endovascular treatment of IAs using the search tool of the Web of Science (WOS). We evaluated the characteristics of these high-impact publications, including publication year, category, journal, author's country, etc. Results The top 100 most cited articles were cited 281.3 times, on average. The United States has published the most articles every year compared with other countries. These highly cited articles are mostly published in the Journal of Neurosurgery. Eighty-six of the top 100 most cited articles were clinical studies. Conclusion The bibliometric analysis provides insight over the development and the growing trend in endovascular treatment of IAs. This study can help researchers better understand the global overview of this field, and it also provides leads about promising areas of future research and potential collaborations.

Resumo Antecedentes O impacto de um relato de literatura sobre um determinado assunto pode ser medido pelo seu número de citações. Objetivo O objetivo deste estudo foi avaliar as características dos relatos da literatura na área de tratamento endovascular de aneurismas intracranianos (AIs), analisando os 100 artigos mais citados. Ressalta-se que o foco deste estudo é descrever as características bibliométricas. Métodos Esta análise bibliométrica foi dedicada apenas ao tratamento endovascular dos AIs em nosso estudo. Pesquisamos os 100 artigos mais citados na área de tratamento endovascular de AIs usando a ferramenta de busca daWeb of Science (WOS). Avaliamos as características dessas publicações de alto impacto, incluindo ano de publicação, categoria, periódico, país do autor etc. Resultados Os 100 artigos mais citados foram citados 281,3 vezes, em média. Os Estados Unidos publicaram o maior número de artigos todos os anos em comparação com outros países. Esses artigos altamente citados são publicados principalmente noJournal of Neurosurgery. Oitenta e seis dos 100 artigos mais citados eram estudos clínicos. Conclusão A análise bibliométrica fornece informações sobre o desenvolvimento e a tendência crescente no tratamento endovascular das AI. Este estudo pode ajudar os pesquisadores a entender melhor a visão global desse campo e também fornece pistas sobre áreas promissoras de pesquisas futuras e potenciais colaborações.

Tratamiento endovascular con técnica de chimenea para patologías del arco aórtico / Endovascular management with chimney technique for pathologies ofthe aortic arch

Introducción. La patología del arco aórtico se ha tratado principalmente con cirugía por vía abierta, pero con una alta morbimortalidad. Las técnicas endovasculares híbridas y las reconstrucciones en "chimenea" son una técnica válida y segura para disminuir el riesgo y la mortalidad. Métodos. Se presentan dos pacientes con patología del arco aórtico y contraindicación de manejo quirúrgico abierto, atendidos en el Servicio de Cirugía Vascular, Hospital Universitario Clínica de San Rafael, Bogotá, D.C., Colombia. Resultados. Se realizaron dos procedimientos endovasculares del arco aórtico para tratar un aneurisma torácico roto y una úlcera aórtica sintomática, con cubrimiento de los troncos supra aórticos con una endoprótesis y canalización de los vasos supra aórticos con prótesis cubiertas y uso de la "técnica de chimenea", de manera exitosa. Discusión. La patología del arco aórtico es de alta complejidad y se asocia con una morbimortalidad elevada por lo que, en los últimos 20 años se han desarrollado diferentes técnicas utilizando procedimientos percutáneos. Conclusión. La "técnica de chimenea" se puede realizar de una manera mínimamente invasiva en pacientes con patología del arco aórtico, no candidatos para cirugía abierta, con resultados exitosos.

Introduction. Aortic arch pathology has been treated mainly by open surgery, but with high morbidity and mortality. Hybrid endovascular techniques and "chimney" reconstructions are a valid and safe techniques to reduce risk and mortality. Method. Two patients with pathology of the aortic arch and contraindication for open surgical management, treated at the Vascular Surgery Service, Hospital Universitario Clínica de San Rafael, Bogotá, Colombia, are presented. Results. Two endovascular aortic procedures were performed successfully to treat a ruptured thoracic aneurysm and a symptomatic aortic ulcer, with coverage of the supra-aortic trunks with an endoprosthesis and cannulation of the supra-aortic vessels with covered prostheses and use of the "chimney technique". Discussion. The pathology of the aortic arch is highly complex and is associated with high morbidity and mortality, being the reason that during the last 20 years, different techniques have been developed using percutaneous procedures. Conclusions. The "chimney technique" can be performed with successful results in a minimally invasive manner in patients with pathology of the aortic arch, who are not candidates for open surgery

A case of permanent vision loss due to a carotidcavernous fistula: importance of early diagnosis / Relato de caso de perda visual secundária a fístuda carótido-cavernosa: a importância de um diagnóstico adequado

ABSTRACT A 97-year-old female presented with spontaneous acute-onset palpebral hyperemia and edema of the right eye that had progressively worsen over the previous three days. These signs did not suggest possible carotid-cavernous fistula until a second examination 72 h later, during which the patient exhibited significant progression. Despite embolization, the patient exhibited sustained corneal edema, clots, and turbidity in the aqueous humor, which resulted in permanent visual loss. A greater level of clinical suspicion for possible carotid-cavernous fistula is warranted on initial presentation of palpebral hyperemia and edema to prevent possible irreversible vision loss.

RESUMO O objetivo deste relato é apresentar o caso de uma paciente de 97 anos com início agudo e espontâneo de hiperemia e edema palpebral. Estes sinais não levaram a uma suspeita diagnóstica de fístula carótido-cavernosa até um segundo momento, quando a paciente apresentou progressão importante do quadro clínico. Apesar da realização de tratamento efetivo com embolização da fístula, a paciente manteve alterações oculares como edema de córnea, coágulos e turvação no humor aquoso, e manteve perda visual definitiva.