Aneurisma humeral verdadero en relación con acceso vascular en paciente trasplantado renal: a propósito de 2 casos clínicos / True brachial artery aneurism following vascular access for haemodialysis in renal trasplant patient. Two case reports

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Pseudooclusión carotídea sintomática: tratamiento quirúrgico y resultados / Symptomatic pseudo-occlusion of the carotid artery: surgical treatment and outcomes

Introducción. Estudios multicéntricos recientes sugieren un dudoso beneficio de la endarterectomía carotídea (EC) en pacientes con pseudooclusión carotídea (POC). Objetivo. Evaluar el resultado clínico y hemodinámico de la EC en las POC sintomáticas. Pacientes y métodos. Entre 1999 y 2005 se intervinieron 13 pacientes con POC interna (3,96% de la cirugía carotídea) sintomáticas: siete con infarto cerebral (53,8%), tres con accidente isquémico transitorio (23,1%), dos con amaurosis fugaz (15,4%) y uno con síncopes de repetición (7,7%). En todos se realizó eco-Doppler y angiografía. Criterios diagnósticos del eco-Doppler: oclusión origen carótida interna, flujo en goteo o señal distal amortiguada. Criterios diagnósticos de la angiografía: obstrucción origen carótida interna con relleno filiforme distal. Se indicó la revascularización quirúrgica en todos ellos. Resultados. En 12 pacientes se pudo revascularizar la carótida interna (92,3%) y en uno se hizo su ligadura (7,7%). Técnica de revascularización: 11 EC y un bypass a carótida interna distal. Morbimortalidad quirúrgica del 0%. Control clínico: 3-69 meses (media: 31,6 meses) mediante eco-Doppler de troncos supraaórticos y transcraneal, encontrándose todos vivos, asintomáticos y con permeabilidad de la carótida interna. La reserva hemodinámica homolateral postoperatoria se ha encontrado normalizada en la mayoría de los pacientes. Conclusiones. Se considera indicada la intervención quirúrgica en casos sintomáticos de POC, ya que logra la repermeabilización de la carótida y la normalización de la reserva hemodinámica en un alto porcentaje, previniendo además la aparición de nueva sintomatología a largo plazo

Introduction. Recent multicentre studies suggest dubious benefits for carotid endarterectomy (CE) in patients with pseudo-occlusion of the carotid artery (POC). Aim. To evaluate the clinical and haemodynamic outcomes of CE in cases of symptomatic POC. Patients and methods. Between 1999 and 2005 interventions were carried out on 13 patients with symptomatic pseudo-occlusion of the internal carotid artery (3.96% of the carotid surgery conducted): seven with cerebral infarction (53.8%), three with transient ischemic attack (23.1%), two with amaurosis fugax (15.4%) and one with recurring syncopes (7.7%). Doppler ultrasonography and angiography recordings were performed in all cases. Diagnostic criteria for Doppler ultrasonography were occlusion with its origin in the internal carotid artery, a drip flow or attenuated distal signals. Diagnostic criteria for angiography were occlusion with its origin in the internal carotid artery with filiform distal filling. Surgical revascularisation was indicated in all cases. Results. The internal carotid artery was revascularised in 12 patients (92.3%) and ligation was performed in one of them (7.7%). Revascularisation technique: 11 CE and one distal internal carotid artery bypass. Surgical morbidity and mortality rates of 0%. Clinical monitoring: 3-69 months (mean: 31.6 months) using transcranial and supra-aortic trunk Doppler ultrasonography; all patients were alive, asymptomatic and with patency of the internal carotid artery. The post-operative homolateral haemodynamic reserve was found to be at normal levels in most of the patients. Conclusions. Surgical intervention is considered to be indicated in symptomatic cases of POC, as it achieves repatency of the carotid artery and normalises the haemodynamic reserve in a high percentage of cases; it also prevents the appearance of new symptoms in the long term

Historia natural de los aneurismas de la aorta torácica / The natural history of thoracic aortic aneurysms

Introducción. La historia natural de los aneurismas de la aorta torácica (AAT) está escasamente documentada debido a la dificultad en el diagnóstico de pacientes asintomáticos con AAT y la falta de estudios de cribado en la población. Su evolución natural es el crecimiento progresivo que concluye en la ruptura, con elevada mortalidad. Desarrollo. Revisión sistemática de la bibliografía publicada en las bases de datos Medline y PubMed mediante las palabras clave indicadas al pie y en especial con la evaluación de los registros informatizados con bases de datos amplias de universidades o sociedades europeas y americanas de cirugía vascular, cardiovascular y torácica. Conclusiones. La supervivencia a cinco años de los pacientes con AAT no tratados es menor del 19%; la causa principal de muerte es la ruptura aneurismática. El tamaño es el factor fundamental de riesgo de ruptura. El riesgo de ruptura aumenta exponencialmente cuando el diámetro de la aorta ascendente supera los 6 cm y el de la aorta descendente los 7 cm, e igualmente cuando se producen crecimientos rápidos. La cirugía mejora la evolución natural de la enfermedad. La historia natural de los AAT está determinada por su tamaño y tasa de crecimiento. El principio de toma de decisiones en el tratamiento de estos enfermos ha de basarse en determinar el riesgo individualizado de complicaciones en su evolución natural (ruptura, disección) frente al riesgo de la corrección quirúrgica en la experiencia del grupo quirúrgico concreto. La cirugía endovascular ha supuesto ya un impacto positivo en la historia natural al permitir la corrección de AAT en pacientes de alto riesgo, sin otras posibilidades previas de tratamiento

Introduction. The literature on the natural history of thoracic aortic aneurysms (TAA) is scarce due to the difficulty involved in diagnosing asymptomatic patients with TAA and the lack of screening studies conducted in the population. Its natural history comprises a progressive growth that ends in rupture, with a high mortality rate. Development. We carried out a systematic search of the literature published in the Medline and PubMed databases using the key words indicated in the footnote below. Additionally and perhaps more important, we also evaluated the computer records in extensive databases from universities and European or American vascular, cardiovascular and thoracic surgery societies. Conclusions. The survival rate of untreated TAA patients at five years is lower than 19%, the main cause of death being aneurysmal rupture. Size is a fundamental factor associated to the risk of rupture. The risk of rupture increases exponentially when the diameter of the ascending aorta exceeds 6 cm and that of the descending aorta goes beyond 7 cm; this is also the true when rapid growth takes place. Surgery improves the natural history of the disease. The natural history of TAAs is determined by their size and growth rate. The principle guiding decision-making in the treatment of these patients must be based on determining the individual risk of complications in their natural history (rupture, dissection) versus the risk involved in surgical correction, according to the experience of each particular surgical group. Endovascular surgery has had a positive effect on the natural history by allowing TAA to be corrected in high-risk patients who previously had no other chances of treatment open to them

Diagnosing external iliac endofibrosis by postexercise ankle to arm index in cyclists.

PURPOSE: The aim of this study was to determine a noninvasive method of evaluating external iliac endofibrosis in cyclists. METHODS: Eighteen highly trained male cyclists were divided into two groups: a pathology group (PG; 3 professional and 4 elite) and a control group (CG; 6 professional and 5 elite). Mean age was 26 +/- 6.1 yr for the PG and 24 +/- 4.09 for the CG. We studied humeral and tibial posterior pressure by using Doppler ultrasound and the ankle to arm index (AAI) before and after an incremental exercise test, performed on bike-ergometer until exhaustion. A Wilcoxon test was used to compare pressures and AAI in the PG. A Mann-Whitney test was used to compare the PG with the CG. Fisher discriminant analysis was done to obtain a classification of the legs in ill or normal legs. RESULTS: The minimal AAI achieved in the PG was 0.76 +/- 0.13 for the normal leg (NL) and 0.35 +/- 0.04 for the ill leg (IL). We found significant differences (P < 0.01) from the 1st to 4th minute after exercise between the NL and the IL in the PG, and from the 1st to 10th minute after exercise between the IL and CG. We found significant differences in leg pressures between NL and IL in PG from the 1st to 4th minute (P < 0.01), and from the 1st to the 10th minute after exercise between CG and IL in the PG. Through discriminant analysis, we obtained a classification of the legs as ill or normal by applying a mathematical function at each recovery time studied. CONCLUSIONS: AAI and leg pressures response to maximal exercise is a valid and noninvasive method for the evaluation of external iliac endofibrosis.