Tratamiento endovascular del aneurisma de aorta: endoleaks tipo II, cuándo y cómo tratarlos / Endovascular treatment of aortic aneurysm: Type II endoleaks, when and how to treat them

INTRODUCCIÓN: Las endofugas tipo II constituyen la principal causa de reoperación a medio y largo plazo utilizando endoprótesis de última generación. Tienen la potencialidad de llevar al crecimiento y ruptura del aneurisma. Exigen un protocolo de seguimiento con imágenes distinto. Sin embargo, no existen pautas claras en cuanto a su algoritmo terapéutico. OBJETIVO: El objetivo del trabajo es analizar los resultados obtenidos del tratamiento de la endofuga tipo II después del tratamiento endovascular del aneurisma de aorta abdominal. MATERIAL Y MÉTODO: Sobre un total de 214 pacientes operados 32 presentaron una endofuga tipo II en el primer control postoperatorio. Quince de ellos desarrollaron una endofuga persistente, pero solo 11 se asociaron a crecimiento del saco aneurismático. El tratamiento consistió en la embolización de las arterias lumbares con coils (8 casos) punción translumbar (un caso), embolización de la arteria mesentérica inferior (AMI) (un caso) y ligadura laparoscópica de la AMI (un caso). Los datos fueron analizados empleando el paquete estadístico Medcalc V. 11.ResultadosMediante técnicas transarteriales o laparoscópicas se obtuvo el tratamiento efectivo de la endofuga, evidenciado por su trombosis y estabilización del saco aneurismático en sucesivos controles tomográficos. No se registró mortalidad, reintervención o ruptura relacionada. CONCLUSIÓN: El estudio demostró que tratar solo aquellas endofugas «persistentes» con crecimiento aneurismático es una conducta segura. Los tratamientos aplicados fueron en este caso efectivos

INTRODUCTION: The treatment of type II endoleaks remains controversial. Their long-term natural history and impact on changes in aneurysm morphology are still under review. OBJECTIVE: The objective of this study is to present a safe and effective approach to treat typeii endoleaks associated to aneurysm sac enlargement. MATERIAL AND METHOD: Out of a total of 214 patients, 32 presented with a type II endoleak in the first post-surgical review. Fifteen of these developed a persistent endoleak, but only 11of them were associated with growth of the aneurysm sac. The treatment consisted of coil embolisation of the lumbar arteries (8 cases), lumbar puncture (one case), embolisation of the inferior mesenteric artery (IMA) (one case), and laparoscopic IMA ligation (one case). The data were analysed using the Medcalc V. 11 statistics package. RESULTS: By transarterial or laparoscopic techniques effective treatment was obtained of endoleak, evidenced by its stabilization thrombosis and aneurysm sac in successive tomographic controls. No mortality or reoperation related rupture occurred. CONCLUSION: Only those patients with persistent typeII endoleak associated with sac enlargement should be treated. Effective techniques were described

Sentinel lymph node biopsy: technique validation at the Setúbal Medical Centre, Portugal.

AIMS: To evaluate the accuracy of sentinel lymph node biopsy in breast cancer patients at this institution, using combined technetium-99m ((99m)Tc) sulphur colloid and patent blue vital dye. METHODS: From March 2007 to July 2008, 50 patients with a tumour of less than 3 cm and with clinically negative axillary lymph nodes underwent sentinel lymph node biopsy (SLNB), followed by axillary lymph node dissection (ALND). Sub-areolar (99m)Tc sulphur colloid injection was performed the day before surgery, and patent blue vital dye was also injected sub-areolarly at least 5 minutes before surgery. Sentinel lymph node was identified during the surgical procedure, using a gamma probe and direct vision. All sentinel nodes underwent frozen section analysis. Later haematoxylin and eosin staining and immunohistochemical analysis were performed. Finally, SLNB was compared with standard ALND for its ability to accurately reflect the final pathological status of the axillary nodes. RESULTS: The sentinel lymph node (SLN) was identified in 48 of 50 patients (96%). The number of sentinel lymph nodes ranged from one to four (mean 1.48) and non-sentinel nodes ranged from seven to 27 (mean 14.33). Of the 48 patients with successfully identified SLNs, 29.17% (14/48) were histologically positive. Sensivity of the SLN to predict axilla was 93.75%; accuracy was 97.96%. The SLN was falsely negative in one patient-6.25% (1/16). CONCLUSIONS: The SLNB represents a major advance in the surgical treatment of breast cancer as a minimally invasive procedure predicting the axillary lymph node status. This validation study demonstrates the accuracy of the SLNB and its reasonable false negative rate when performed in our institute. It can now be used as the standard method of staging in patients with early breast cancer at this institution.