Thrombosed Popliteal Artery Pseudoaneurysm as Herald of Tibial Osteochondroma.

BACKGROUND: Osteochondroma is the most common non-malignant tumour of bone, accounting for approximately one third of benign lesions in the skeleton. They often develop around the knee in the distal femur and in the proximal tibia and fibula. They present as a painless slow growing mass during adolescence and have been reported to cause damage to adjacent structures such as blood vessels; arterial damage is more common than venous injury and is usually a result of compression, stretching, and rubbing of the arterial wall. Such lesions include stenosis, thrombosis, and pseudoaneurysm formation possibly causing lower limb claudication or acute limb ischemia. METHODS: An 18 year old male patient with a 4 week history of pain, hematoma, and oedema of the left calf without previous trauma is reported. A computed tomography scan (CT) revealed a large popliteal artery pseudoaneurysm and its close relationship to a protrusion of the proximal tibia. RESULTS: The popliteal artery was repaired by an external saphenous patch and the exostosis was removed. The patient had palpable popliteal and distal pulses after surgery and during the first year follow-up. CONCLUSIONS: Tibial osteochondroma should be considered in the differential diagnosis in young patients, among the potential causes of pseudoaneurysm of the femoral or popliteal artery. Surgical repair should be performed to restore normal blood flow with resection of the exostosis to prevent recurrence.

Morbimortalidad de los aneurismas de aorta abdominal rotos durante la implantación del tratamiento endovascular en nuestro centro / Morbidity and mortality of ruptured abdominal aortic aneurysms during endovascular treatment

OBJETIVO: Valorar la mortalidad y complicaciones postoperatorias durante el primer mes de los aneurismas de aorta abdominal rotos (AAAr), en función de la técnica quirúrgica empleada, reparación endovascular de aneurisma (EVAR). Analizar los factores pronósticos que influyen en la mortalidad. MATERIAL Y MÉTODOS: Estudio de cohortes históricas de los pacientes con AAAr infrarrenales y yuxtarrenales sometidos a tratamiento quirúrgico (EVAR o cirugía abierta) en nuestro centro. Los criterios de elección para EVAR son anatomía favorable y estabilidad hemodinámica. Las variables recogidas fueron características demográficas, factores de riesgo cardiovascular y patología asociada, técnica quirúrgica, lugar de procedencia, demora en la intervención, situación preoperatoria, complicaciones médico-quirúrgicas postoperatorias, estancia en unidad de reanimación posquirúrgica (URP) y en planta de hospitalización y mortalidad. RESULTADOS: Entre enero de 2011 y agosto del 2013 se intervinieron 31 varones con edad media de 71 años. La mortalidad global fue del 45% (mortalidad del 61% en cirugía abierta frente al 23% con EVAR, p 0,06). Hipotensión preoperatoria < 80 mmHg (p < 0,004), creatinina > 2,1 mg/dl (p 0,018) e inestabilidad hemodinámica en quirófano (p < 0,05) se asocian con la mortalidad de forma significativa, independientemente de la técnica quirúrgica empleada. La estancia media en URP fue de 10 días en cirugía abierta frente a 2 días en EVAR (p 0,04). La estancia media hospitalaria fue de 19 días en cirugía abierta frente a 6,5 días en EVAR. CONCLUSIONES: La introducción del EVAR para el tratamiento de los AAAr en nuestro centro ha disminuido la morbimortalidad, la estancia media en URP y en planta de hospitalización

OBJECTIVE: A study was conducted on the 30-day mortality and postoperative complications after endovascular repair (EVAR) and open surgery in patients with ruptured abdominal aortic aneurysms (rAAA). An analysis was made of the prognostic factors influencing the mortality. MATERIAL AND METHODS: A review was conducted on a cohort of patients with infrarenal and juxtarenal rAAA undergoing surgical treatment (EVAR and open surgery). The selection criteria used for EVAR were favourable anatomy and hemodynamic stability. The variables collected were demographic characteristics, cardiovascular risk factors and associated diseases, surgical technique, place of origin, delayed intervention, preoperative status, postoperative medical and surgical complications, postoperative stay in intensive care unit (ICU) and days of hospital stay, and mortality. RESULTS: A total of 31 males with a mean age of 71 years were operated on between January 2011 and August 2013. Mortality was 45% (a mortality of 61% in open surgery compared to 23% with EVAR, p = .06). Variables significantly associated with 30-day mortality were preoperative hypotension < 80 mmHg (p = 0.004), creatinine > 2.1 mg / dl (p = 0.018), and hemodynamic instability during surgery (p < 0.05), regardless of the surgical technique used. The average stay in the ICU was 10 days in open surgery versus 2 days for EVAR (p = 0.04). The average hospital stay was 19 days in open surgery versus 6.5 days for EVAR. CONCLUSIONS: EVAR for treatment of rAAA in this hospital has decreased morbidity and mortality rates, the average stay in ICU, and hospitalization stay

Pseudoaneurisma de troncos distales de miembros inferiores tras traumatismo. ¿Tratamiento de elección endovascular o abierto? / Pseudoaneurysm of the distal arteries of the lower limbs after injury. Endovascular or open treatment?

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