[Percutaneous revascularization of chronic iliac artery occlusions with primary stent placement]. / Recanalización percutánea de oclusiones crónicas de arterias ilíacas con instalación primaria de stent.

BACKGROUND: Percutaneous transluminal angioplasty is a well established treatment method for aorto iliac stenoses. However its success is limited in arterial occlusions and vascular stent placement can improve the results. AIM: To assess the effectiveness of percutaneous revascularization with stent placement in patients with chronic iliac artery occlusions. PATIENTS AND METHODS: Twenty six patients (18 male) aged 47 to 82 years, with iliac artery occlusions lasting six or more weeks were treated. Fourteen had involvement of common iliac artery, five had involvement of external iliac artery and seven of both. The occluded segment length ranged from 3.5 to 12 cm. According to the Society of Cardiovascular Surgery/International Society for Cardiovascular Surgery classification, 22 patients had category 1 claudication, 10 were in category 2, 12 in category 3 and two in category 4. RESULTS: A technical success was obtained in 23 patients and clinical success in 21. After the intervention, the anklearm index improved from 0.49 +/- 0.12 to 0.88 +/- 0.18 (p < 0.001). Permeability after 12 months of follow up was 81% and after 36 months, 65%. Four patients had complications; one had a vascular perforation, two had an acute occlusion and one had an asymptomatic distal embolization. All these were solved using endovascular techniques. CONCLUSIONS: Percutaneous revascularization with stent placement is a valid alternative to surgery in selected patients with chronic iliac artery occlusion.

[Percutaneous transluminal angioplasty (PTA) and intravascular stents in the treatment of central and peripheral venous stenoses of arteriovenous fistulae for chronic hemodialysis]. / Angioplastía transluminal percutánea (ATP) y endoprótesis en el tratamiento de estenosis venosas centrales y periféricas, de fístulas arteriovenosas para hemodiálisis crónica.

BACKGROUND: The maintenance of permeable vascular accesses in chronic hemodialysis patients is a major challenge. AIM: To report our experience in the percutaneous treatment of venous stenoses of arteriovenous fistulae for hemodialysis. PATIENTS AND METHODS: We studied retrospectively 48 patients with arteriovenous fistulae stenoses, that were followed during 24 months. When the fistulography disclosed an stenosis, a percutaneous transluminal angioplasty was performed. If indicated, an intravascular stent was installed or thrombolysis was done. These procedures were repeated as needed. RESULTS: Twenty four patients had a peripheral vein stenosis, 20 had subclavian vein stenosis and 4 had both veins compromised. All were dilated with percutaneous transluminal angioplasty. Five stents were installed in the subclavian vein and five in peripheral veins. Two patients required thrombolysis. The procedure was successful in 96% of peripheral lesions and 92% of central lesions. There was regression of superior limb edema in 16 of 20 patients. Five patients had an hematoma in the puncture site. Twelve months later, 61% of treated peripheral and 42% of subclavian treated veins remained patent. CONCLUSIONS: The use of percutaneous transluminal angioplasty and intravascular stents, maintains long term arteriovenous fistulae permeability and has similar results to surgical procedures.

[Diagnostic role of the combination of computerized tomography and angiography in traumatic injuries of the thoracic aorta]. / Rol diagnóstico de la combinación tomografía computada--angiografía en lesiones traumáticas de la aorta torácica.

AIM: To assess the diagnostic value of the combination of computed tomography and angiography in patients with blunt thoracic trauma and suspicion of aortic injury. PATIENTS AND METHODS: Retrospective analysis of six patients, aged 22 to 72 years old, with traumatic thoracic aorta injury secondary to severe trauma, specially car accidents, seen between 1985 and 1994. RESULTS: An early diagnosis was done in three patients. One patient, in whom diagnosis was delayed, died before surgery. In three cases, CAT scan showed indirect evidence of aortic rupture, consisting in alterations of aortic outline. In other three patients, it showed hemomediastinum, associated to a left hemothorax in one case. Angiography confirmed the diagnosis, localized and characterized the injury in all patients. CONCLUSIONS: The delay in the diagnosis of aortic injury may be fatal. The combination of CAT scan and angiography has a high sensitivity and specificity to localize and characterize lesions of the aorta or its branches or associated organs, essential step for surgical planning. CAT scan restricts the use of angiography, avoiding false negative studies, but cannot be used as the sole diagnostic procedure.

[Hypomagnesemia associated with hypokalemia, hyponatremia and metabolic alkalosis. Possible complication of gentamycin therapy]. / Hipomagnesemia asociada con hipokalemia, hiponatremia y alcalosis metabolica. Posible complicacion del uso de gentamicina.

Hypomagnesemia is a serious abnormality with different causes and usually associated to other disorders of electrolyte metabolism. We report a female patient developing hypomagnesemia after administration of gentamycin. This was associated to severe hypokalemia, hyponatremia and metabolic alkalosis. Possible pathogenetic mechanisms and therapeutic measures are discussed.