Protocolo y algoritmo de diagnóstico, tratamiento y derivación ágil de las úlceras de la extremidad inferior / Protocol and algorithm for diagnosis, treatment and early referral of lower limb ulcers

Las úlceras venosas son una patología muy prevalente, especialmente en pacientes de edad avanzada. repercutennegativamente en la calidad de vida de los pacientes y conllevan un importante consumo de recursos. este artículopropone un práctico algoritmo para el diagnóstico y el tratamiento de las úlceras en la pierna con el objetivo deoptimizar su manejo. existe una amplia literatura sobre el tema, pero sigue existiendo una brecha entre la evidenciacientífi ca y la práctica clínica que seguimos tratando de minimizar. Laboratorios Urgo propuso al Capítulo español de Flebología y Linfología la creación de un comité de expertos deespaña y portugal para la elaboración de un algoritmo de diagnóstico, tratamiento y derivación ágil de las úlcerasen la extremidad inferior. Se realizó una búsqueda bibliográfica sistemática y se tuvieron en cuenta las guías depráctica clínica (GpC). Se diseñó un algoritmo sobre una regla nemotécnica alfabética que busca ayudar a memorizar los pasos clave deldiagnóstico y del tratamiento de estas úlceras. Se englobaron todos los aspectos prácticos, desde la valoración en atención primaria por médicos y enfermerashasta la atención especializada por el especialista en angiología y cirugía vascular. Con las letras del abecedario dela a hasta la F, resumimos los pasos necesarios para asegurar el diagnóstico de la úlcera, el mejor (best) tratamientolocal, terapia compresiva, tratamiento preventivo de recidiva después de la cicatrización de la úlcera y estrategiaquirúrgica y farmacológica.el diagnóstico preciso, la actuación correcta ajustada a las GpC y la derivación temprana para valorar estrategiasquirúrgicas o escleroterapia contribuyen a la resolución y a la reducción del tiempo de cicatrización de las úlcerasy la mejora de la calidad de vida de los pacientes. Seguir las GpC a través de un algoritmo reduce el consumo derecursos y de gasto, acelerando la cicatrización de la úlcera y previniendo su recidiva.(AU)

Venous ulcers are a prevalent disease, especially in elderly patients. they have a negative impact in patients’ qualityof life and carry a significant economic burden. this article suggests an algorithm for the diagnosis and treatment oflower extremity ulcers in order to optimize their management. there is huge evidence and multiple organizationshave published guidelines, consensus documents and treatment recommendations. nevertheless, there is still agap between evidence and clinical practice. Urgo Laboratories proposed the Spanish phlebology and Lymphology Chapter the creation of a Spanish andportuguese experts committee the elaboration of an algorithm for diagnosis and treatment and early referral oflower extremity ulcers. a systematic review was performed, considering the current clinical practice guidelines. the algorithm was designed on a simple alphabetic mnemonic rule aiming to easily memorize the key points andmost relevant issues of the diagnosis and treatment of these ulcers.all necessary steps from primary care nurses and physicians to Vascular Surgery were considered. With the alphabetletters from a to F in Spanish, all key points were summed up. to confirm ulcer diagnosis (asegurar el diagnóstico dela úlcera), best local treatment, compressive therapy, preventive treatment after healing (tratamiento preventivo derecidiva después de la cicatrización de la úlcera), surgical strategy (estrategia quirúrgica) and pharmacological strategy(estrategia farmacológica).an accurate diagnosis, a clinical practice according to the clinical practice guidelines and an early referral to thespecialist in order to determine if there is a surgical or interventional strategy are essential to effective resolutionand reduction of ulcer healing time, and finally to prevent its recurrence.(AU)

Trucos y consejos para optimizar el tiempo de cateterización de arterias visceralesen dispositivos fenestrados (FEVAR) / Tips and tricks to optimize catheterization time of target vessel in fenestrated devices (FEVAR)

Introducción: el tratamiento de aneurismas complejos mediante FEVAR incluye entre sus objetivos un tiempoquirúrgico reducido para poder alcanzar el éxito técnico y clínico. Sin embargo, la canulación y el implante de losstents puente en múltiples arterias viscerales pueden suponer un factor limitante. Para evitar un tiempo de escopia y una dosis de radiación prolongados existen algunas maniobras que pueden ayudar a optimizar el tiempo de cateterización. Material y métodos: se realiza una revisión de los últimos casos tratados mediante endoprótesis fenestradas custom made de Zenith Cook® durante el año 2021 en un servicio de angiología, cirugía vascular y endovascular. El objetivo es mostrar las técnicas que sirven para optimizar el tratamiento de aneurismas complejos y que el cirujano puede emplear con el material habitual. Para ello se muestran varios fragmentos de vídeos de estos procedimientos grabados con el sistema OneView. Resultados: el primer paso clave consiste en la liberación del dispositivo fenestrado. La endoprótesis de Cook® presenta una o varias ligaduras de reducción que la mantienen fruncida hasta garantizar una correcta orientación y un correcto posicionamiento. Asimismo, ofrece la opción de canular las arterias viscerales entre la pared arterial y el dispositivo. Con una planifi cación adecuada y un abordaje sistematizado, el uso de guías coaxiales, catéteres de punta simple o reversa e introductores es esencial. El techo de la endoprótesis permite el avance de guías y de introductores con el soporte sufi ciente para su canulación. Los sistemas precargados permiten la canulación desde el miembro superior o el inferior. En este último caso, se utiliza una guía buddy de 0,014" que ofrece soporte al introductor, ya que lo acerca más aún a la fenestración, de tal modo que potencia el momento de torsión (torque) y el empuje del catéter.

Introduction: the treatment of complex aneurysms using FEVAR includes among its objectives a reduced surgicaltime in order to achieve technical and clinical success. However, cannulation and implantation of bridging stentsin multiple visceral arteries can be a limiting factor. To avoid a protracted scope time and radiation dose, there aresome maneuvers that can help optimize catheterization time. Material and methods: a review of the last cases treated with custom made Zenith Cook® fenestrated endoprostheses during the year 2021 is performed in an angiology, vascular and endovascular surgery service. The objective is to show video clips recorded with the OneView system of these techniques that the surgeon can use with the usual material to optimize the treatment of complex aneurysms.Results: the first key step is the release of the fenestrated device. The Cook® endoprosthesis has one or morereduction ligatures that keep it puckered until it guarantees correct orientation and positioning, as well as theoption of cannulating the visceral arteries between the arterial wall and the device.With proper planning and a systematic approach, the use of coaxial guides with single or reverse tip cathetersand introducers are essential. The roof of the endoprosthesis allows the advancement of guides and introducerswith sufficient support for their cannulation. The preloaded systems allow cannulation from the upper or lowerlimb. In the latter case, a 0.014” buddy guide is used to provide support for the introducer, bringing it even closerto fenestration in such a way as to enhance the torque and thrust of the catheter.

Applicability of Zenith p-branch Standard Fenestrated Endograft in Our Series.

BACKGROUND: In the endovascular treatment of abdominal aortic aneurysm (AAA) with short or absent infrarenal neck, the delay in the availability of fenestrated device and its high cost, have led to the manufacture of standardized models. Another option is the endografts with stents in parallel; however, regulated criteria for their use and long-term studies are lacking. The aim of this study was to assessed whether the AAA treated with fenestrated device or stents in parallel in our department, complied with the characteristics for the placement of the new endograft p-branch(®). Furthermore, the differences between the p-branch and the implanted prosthesis were analyzed. METHODS: Single-center and descriptive study of 41 aneurysms treated consecutively from 2008 to 2015. The anatomic characteristics analyzed were: relative distances between the visceral arteries, time position, diameter in the sealing area and number of fenestrations, and its compatibility with the p-branch. RESULTS: The anatomic compatibility rate with the p-branch options was 73.2% (30 cases). Of the 11 incompatible cases, 6 were due to misalignment of the visceral branches, 2 due to the aortic neck diameter being greater, another because the femoral access was inappropriate, and 2 more due to the fenestration configuration. Of the 30 cases in which compatibility existed, in 12 (40%) the configuration used coincided with the p-branch. In 13 cases, the number of fenestrations was higher than those actually used, with 23 fenestrations carried out and 39 hypothetical fenestrations with the new endograft. In the 5 remaining cases, a fenestration for the celiac trunk was necessary to achieve an adequate seal. CONCLUSIONS: The p-branch could meet the needs of three-quarters of the aortic anatomies of our series, with favorable expectations on cost and waiting time. However, in most cases either a higher number of fenestrations are needed for visceral arteries or the proximal seal was shorter than would be ideal.

Predictors of cervical bleeding after carotid endarterectomy.

BACKGROUND: The aim of this study is to determine the incidence of severe cervical bleeding requiring reintervention after carotid endarterectomy (CEA), to identify its predictive parameters, and to find out the influence of these on major complications. METHODS: This was a retrospective review of 502 CEAs carried out in 455 consecutive patients between 1995-2011 in our institution. The end points were: postoperative cervical bleeding that required reoperation and major postoperative complications (i.e., stroke, myocardial infarction, and death). Patients' demographics, antiplatelet and anticoagulant treatment, anaesthetic technique, surgical details, and perioperative management were registered. The end point predictors were univariate and multivariate analyzed. RESULTS: Neck bleeding after CEA occurred in 42 cases (8.4%), requiring reoperation in 28 cases (5.6%). In the univariate analysis, chronic anticoagulation and anticoagulation 24 hours before surgery were associated with reoperation for bleeding (16.6% vs. 4.8% [P = 0.02] and 17.8% vs. 4.7% [P = 0.014], respectively). The agent used for antiplatelet treatment before surgery was related to reoperation in the univariate analysis and was the only factor with statistical significance in the multivariate analysis: acetylsalicylic acid (ASA) 100 mg (2.4%), ASA 300 mg (1.5%), clopidogrel 75 mg (7.8%), ASA 100 mg associated with clopidogrel (3.3%), triflusal (5.5%), and ticlopidine (2.2%); there was a higher incidence of reoperation only in the group of patients who had taken clopidogrel 24 hours before CEA (4.7% vs. 1.05% [P = 0.06], respectively) but without statistical significance (odds ratio: 2; 95% confidence interval: 0.95-4.84). No reoperations were registered using vein patch compared to prosthetic patch (0% vs. 6.1% [P = 0.028]). Conversion to general anesthesia (22.2% vs. 4.9% [P = 0.014]) and noncontrollable postoperative hypertension (6.9% vs. 2.5% [P = 0.028]) were associated with a higher rate of reoperation. There were no statistically significant differences in the reoperation rates related to bleeding for anesthetic technique (local versus general), surgical procedure (classic endarterectomy versus eversion technique), type of prosthetic patch (Dacron/politetrafluoroethylene), use of shunt, intraoperative dose of heparin, protamine reversal, activated clotting time monitoring, or surgeon qualification level. The combined rate of stroke mortality was 2.6%. Reoperation for bleeding was not associated with an increased rate of thrombosis, stroke, death, or injury of cranial nerves. CONCLUSIONS: Postoperative severe bleeding after carotid surgery in our institution is not an uncommon complication. Its incidence is within the range reported in the literature, but it is not associated with major complications or mortality. Antiplatelet treatment with clopidogrel is the main risk factor associated with reintervention. Other factors, such as coagulation control, postoperative hypertension management, and the use of an autologous patch, could help reduce its incidence.

Historia natural de la estenosis carotídea de grado moderado en pacientes con enfermedad arterial periférica / Natural history of moderate-degree carotid stenosis in patients with peripheral artery disease

Fundamento y objetivo: Conocer la evolución de la estenosis carotídea moderada asintomática, losfactores que influyen en la progresión y la morbimortalidad relacionada. Pacientes y método: Estudio observacional retrospectivo de 133 pacientes con estenosis carotídea asintomática entre 50-69% en una o ambas carótidas entre 2002 y 2009. Se incluyen pacientes sometidos a cribado por enfermedad arterial periférica (EAP), patología aneurismática o soplo carotíeo. El seguimiento se realiza mediante ecodoppler anual. Se valora el grado de progresión, variables relacionadas con esta, la aparición de episodios neurológicos y mortalidad global y cardiovascular. Se ha realizado un estudio descriptivo, análisis univariante (ji al cuadrado y t de Student), análisis multivariante (regresión logística) y curvas de supervivencia (test de Log-Rank). Resultados: Con un tiempo medio (DE) de seguimiento de 30,8 (1,7) meses, se observó progresión de la estenosis en el 33% de los pacientes, con un tiempo medio de progresión de 31 3 (2,7) meses. Se registró una mayor tasa de progresión en el subgrupo de pacientes que asociaban EAP y cardiopatía isquémica (odds ratio [OR] 2,84, intervalo de confianza del 95% [IC 95%] 1,14-7,03). En el análisis multivariante tan solo la EAP se presenta como un factor de riesgo de progresión (p = 0,043). El grupo de pacientes con progresión presentó mayores tasas de episodios neurológicos (15 frente a 1,6%, p = 0,01), mayor mortalidad global (15 frente a 3%, p = 0,04) y mayor mortalidad cardiovascular (12,1 frente a 1,5%, p = 0,03). Conclusiones: La progresión de estenosis carotídea asintomática entre el 50-69% es frecuente en pacientes sometidos a cribado, especialmente en aquellos con antecedentes de cardiopatía isquémica y/o EAP. Esta progresión se asocia a una mayor tasa de complicaciones cardiovasculares. Por ello recomendamos el seguimiento clínico y ecográfico de estos pacientes (AU)

Background and objective: To understand the evolution of moderate asymptomatic carotid stenosis, the factors that influence its progression and the related morbimortality. Patients and methods: Retrospective observational study of 133 patients with asymptomatic carotid stenosis between 50-69% in one or both carotids between 2002 and 2009. Included patients were subjected to screening for peripheral arterial disease (PAD), aneurysmal disease or carotid bruit. The monitoring was carried out using an annual duplex scan. The rate of progression, the variables related to this, the appearance of neurological events, and global and cardiovascular mortality were evaluated. Descriptive studies, univariate analysis (chi-squared test and Student’s t-test), multivariate analysis (logistic regression), and survival curves (Log-Rank test) were carried out. Results: With an average time of monitoring: 30.8 1.7 months, stenosis progression was observed in 33% of the patients, with an average progression time of 31.3 2.7 onths. Greater progression was observed in the subgroup of patients with PAD and ischemic heart disease (odds ratio [OR] 2.84, confidence interval [CI] 95% 1.14-7.03). In the multivariate analysis only the PAD was identified as a risk factor for progression (P = .043). The group of patients with progression showed greater rates of neurological events: 15 vs. 1.6% (P = .01), greater global mortality: 15 vs. 3% (P = .04), and greater cardiovascular mortality: 12.1 vs. 1.5% (P = .03). Conclusions: The progression of asymptomatic carotid stenosis between 50-69% is common in patients subjected to screening, especially in those with a history of ischaemic heart disease and/or PAD. This progression is associated with an increased rate of cardiovascular complications. For this reason, we recommend clinical and echographic follow-up of these patients (AU)

[Natural history of moderate-degree carotid stenosis in patients with peripheral artery disease]. / Historia natural de la estenosis carotídea de grado moderado en pacientes con enfermedad arterial periférica.

BACKGROUND AND OBJECTIVE: To understand the evolution of moderate asymptomatic carotid stenosis, the factors that influence its progression and the related morbimortality. PATIENTS AND METHODS: Retrospective observational study of 133 patients with asymptomatic carotid stenosis between 50-69% in one or both carotids between 2002 and 2009. Included patients were subjected to screening for peripheral arterial disease (PAD), aneurysmal disease or carotid bruit. The monitoring was carried out using an annual duplex scan. The rate of progression, the variables related to this, the appearance of neurological events, and global and cardiovascular mortality were evaluated. Descriptive studies, univariate analysis (chi-squared test and Student's t-test), multivariate analysis (logistic regression), and survival curves (Log-Rank test) were carried out. RESULTS: With an average time of monitoring: 30.8 ± 1.7 months, stenosis progression was observed in 33% of the patients, with an average progression time of 31.3 ± 2.7 months. Greater progression was observed in the subgroup of patients with PAD and ischemic heart disease (odds ratio [OR] 2.84, confidence interval [CI] 95% 1.14-7.03). In the multivariate analysis only the PAD was identified as a risk factor for progression (P=.043). The group of patients with progression showed greater rates of neurological events: 15 vs. 1.6% (P=.01), greater global mortality: 15 vs. 3% (P=.04), and greater cardiovascular mortality: 12.1 vs. 1.5% (P=.03). CONCLUSIONS: The progression of asymptomatic carotid stenosis between 50-69% is common in patients subjected to screening, especially in those with a history of ischaemic heart disease and/or PAD. This progression is associated with an increased rate of cardiovascular complications. For this reason, we recommend clinical and echographic follow-up of these patients.

Endovascular repair of an iliac arteriovenous fistula secondary to perforation from a common iliac aneurysm in a patient with Ehler-Danlos syndrome.

BACKGROUND: Type IV Ehler-Danlos syndrome (EDS) patients are prone to life-threatening vascular complications. Surgical management of those complications is challenging owing to vessel wall fragility, which may result in hemorrhagic events and high mortality rates. Here we report a case of left common iliac aneurysm perforation of the ipsilateral iliac vein repaired using endovascular technique in a patient with EDS. METHOD AND RESULTS: A 54-year-old patient presented with heart failure symptoms that evolved over 1 week in association with left leg edema and steal syndrome due to a perforation of the left iliac vein caused by a left common iliac aneurysm. A thrombosed right common iliac aneurysm and several other visceral and peripheral aneurysms were discovered on computed tomographic scan at admission. An aortouniiliac stent graft was used to seal the fistula. After 18 months of follow-up, the patient remained asymptomatic. CONCLUSIONS: We suggest that endovascular therapy is useful to manage vascular complications in patients with EDS.

[Clinical and therapeutic characteristics of limb emboli]. / Características clínicas y terapéuticas de las embolias de extremidades.

INTRODUCTION: To treat an extremity embolus seems to be a simple and safe procedure. However, it is not exempt from potentially serious complications. We review our experience of treating acute peripheral arterial occlusion due to emboli. PATIENTS AND METHOD: We retrospectively analyzed the data of 127 embolectomies performed during the last five years, in 120 extremities in 116 patients. The mean age of the patients was 80 years and 66% were female. All cases were presented as acute threatened limb ischemia grades IIA or IIB, and the mean evolution time was 27 hours. The patency, limb salvage and morbidity-mortality rates in the postoperative period and the salvage and survival rates in the follow-up were analyzed. RESULTS: Of the embolectomies, 55% were femoral and 30% brachial. Although 90% of the cases improved, only 75% of them recovered distal pulses. In the postoperative period the patency, limb salvage, morbidity and mortality rates were 90%, 96%, 13% and 6.4%, respectively. The mean follow-up was 24 months. Up until this time, the patency and survival rates are 91% and 61%, respectively. The only factor related with an increase in the amputation rate was a clinical presentation, such as a threatened immediate ischemia. The factors related with an increase in survival rate were appropriate cardiological treatment and control, and long-term anticoagulation treatment. CONCLUSIONS: Suffering an embolus of the extremities and its treatment causes considerable morbidity-mortality and limb amputation rates. The extremity salvage is associated with the clinical presentation at the time of the treatment. Long-term anticoagulation treatment and appropriate cardiological control increase the survival of these patients.

Características clínicas y terapéuticas de las embolias de extremidades / Clinical and therapeutic characteristics of limb emboli

Introducción. Tratar una embolia arterial de las extremidades resulta un procedimiento sencillo, seguro y resolutivo. Sin embargo, no es un proceso exento de complicaciones potencialmente graves. Material y método. Se han analizado retrospectivamente las 127 embolectomías realizadas, en los últimos 5 años, en 120 extremidades de 116 pacientes. La media de edad fue 80 años y el 66% eran mujeres. La mayoría se manifestó como isquemias agudas con amenaza de la extremidad, de una media de 27 h de evolución. Se han analizado las tasas de permeabilidad, salvamento y morbimortalidad postoperatorias y de salvamento y supervivencia a medio plazo en el seguimiento. Resultados. El 55% de las embolectomías fueron femorales y el 30%, humerales. El 90% de los casos mejoraron clínicamente, aunque sólo el 75% recuperó pulsos distales. En el postoperatorio los resultados fueron: permeabilidad del 90%, salvamento del 96%, morbilidad del 13% y mortalidad del 6,4%. El seguimiento medio fue 24 meses. Al final del seguimiento medio, los resultados fueron: salvamento de extremidad del 91% y supervivencia del 61%. El único factor relacionado con un incremento en la tasa de amputación fue la presentación clínica como una isquemia aguda con amenaza inmediata (frente a amenaza inicial). Los factores relacionados con una mejor supervivencia fueron unos adecuados tratamiento y control cardiológico y una anticoagulación prolongada a dosis ajustadas. Conclusiones. Sufrir una embolia de extremidades y su tratamiento mediante embolectomía producen tasas de morbimortalidad y amputación no desdeñables. El salvamento de la extremidad está relacionado con la clínica en el momento del tratamiento. La anticoagulación prolongada y el control cardiológico aumentan la supervivencia de estos pacientes (AU)

Introduction. To treat an extremity embolus seems to be a simple and safe procedure. However, it is not exempt from potentially serious complications. We review our experience of treating acute peripheral arterial occlusion due to emboli. Patients and method. We retrospectively analyzed the data of 127 embolectomies performed during the last five years, in 120 extremities in 116 patients. The mean age of the patients was 80 years and 66% were female. All cases were presented as acute threatened limb ischemia grades IIA or IIB, and the mean evolution time was 27 hours. The patency, limb salvage and morbidity-mortality rates in the postoperative period and the salvage and survival rates in the follow-up were analyzed. Results. Of the embolectomies, 55% were femoral and 30% brachial. Although 90% of the cases improved, only 75% of them recovered distal pulses. In the postoperative period the patency, limb salvage, morbidity and mortality rates were 90%, 96%, 13% and 6.4%, respectively. The mean follow-up was 24 months. Up until this time, the patency and survival rates are 91% and 61%, respectively. The only factor related with an increase in the amputation rate was a clinical presentation, such as a threatened immediate ischemia. The factors related with an increase in survival rate were appropriate cardiological treatment and control, and long-term anticoagulation treatment. Conclusions. Suffering an embolus of the extremities and its treatment causes considerable morbidity-mortality and limb amputation rates. The extremity salvage is associated with the clinical presentation at the time of the treatment. Long-term anticoagulation treatment and appropriate cardiological control increase the survival of these patients (AU)

[Value of the Doppler-ultrasonography for the diagnosis of temporal arteritis]. / Valor de la ecografía Doppler en el diagnóstico de la arteritis de la temporal.

BACKGROUND AND OBJECTIVE: The aim of this study was to investigate the accuracy of color Doppler-ultrasonography (CDU) compared with biopsy for the diagnosis of temporal arteritis (TA). PATIENTS AND METHOD: Twenty-three patients with suspected TA on the basis of clinical criteria were evaluated with CDU prior to temporal artery biopsy. The presence of a hypoechoic halo, suggesting edema of the inflamed vessel, and inflammatory stenoses were registered. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and eficiency or global test value (GTV) were evaluated. RESULTS: All patients completed a bilateral CDU examination of temporal arteries, and in 72% of patients the biopsy was negative for TA. When the presence of an halo in CDU examination was regarded as determinant for disease, sensitivity, specificity, PPV, NPV and GTV compared with TA histologic confirmation were 80%, 92%, 80%, 92% and 88%, respectively. When the criteria used was presence of the halo sign with or without inflammatory stenosis, the values were 100%, 77%, 62.5%, 100% and 83% respectively. CONCLUSIONS: Because of the high sensitivity and NPV, we consider CDU as a good screening test for the diagnosis of TA.

Derivaciones femorodistales perimaleolares en pacientes en hemodiálisis / Perimalleolar femorodistal bypasses in haemodialysis patients

Introducción. El incremento en la prevalencia de la enfermedad renal terminal y el aumento de la supervivencia de los pacientes sometidos a hemodiálisis hace que cada vez sean más frecuentes las manifestaciones arterioescleróticas avanzadas en sus miembros inferiores. Objetivo. Comparar los resultados inmediatos y a medio plazo de las derivaciones femorodistales perimaleolares realizadas en pacientes sometidos a hemodiálisis con los de los pacientes sin tratamiento renal sustitutivo. Pacientes y métodos. Se comparan los resultados obtenidos en dos grupos de pacientes: 36 derivaciones en 29 pacientes en hemodiálisis frente a 96 derivaciones en 87 pacientes sin hemodiálisis, realizadas en los últimos 10 años. Las características demográficas y clínicas fueron similares entre ambos grupos, excepto en una mayor presencia de hipertensión arterial en el grupo de pacientes en hemodiálisis. Se analizaron los resultados en el postoperatorio inmediato y durante el seguimiento. Resultados. En ambos grupos, la técnica más utilizada fue la derivación femoropedia con la vena safena invertida. En el postoperatorio inmediato, los pacientes en hemodiálisis presentaron una morbilidad mayor que los pacientes sin hemodiálisis (p = 0,03), debido a una mayor incidencia de complicaciones generales. El seguimiento medio en ambos grupos fue de 36 meses y durante este período los pacientes en hemodiálisis presentaron una menor supervivencia media (p = 0,02), debida a una mayor mortalidad cardiológica. Conclusiones. Las derivaciones femorodistales perimaleolares son técnicas de salvamento de la extremidad factibles en pacientes en hemodiálisis, con resultados vasculares comparables a los de los pacientes sin hemodiálisis. Sin embargo, los pacientes en hemodiálisis presentan una mayor morbilidad postoperatoria y una menor supervivencia media

Introduction. The rise in the prevalence of terminal kidney disease and the increased survival of patients submitted to haemodialysis are making advanced arteriosclerotic manifestations in their lower limbs increasingly more frequent. Aim. To compare the immediate and medium-term outcomes of perimalleolar femorodistal bypasses carried out in patients submitted to haemodialysis with those of patients who do not require renal replacement therapy. Patients and methods. We compared the outcomes obtained in two groups of patients, namely, 36 bypasses in 29 haemodialysis patients versus 96 bypasses carried out in 87 patients who did not require haemodialysis, performed over the last 10 years. The demographic and clinical characteristics of the two groups were similar, except for a greater presence of arterial hypertension in the group of haemodialysis patients. Outcomes in the immediate post-operative period and during the follow-up were analysed. Results. In both groups the most widely used technique was a femoral-dorsalis pedis bypass with inverted saphenous vein. In the immediate post-operative period, patients undergoing haemodialysis presented a higher rate of morbidity than patients who did not require haemodialysis (p = 0.03), owing to a higher incidence of general complications. The mean follow-up time in the two groups was 36 months and during this period the haemodialysis patients presented a lower mean rate of survival (p = 0.02), due to a higher rate of mortality from heart pathologies. Conclusions. Perimalleolar femorodistal bypasses are limb salvage techniques that are feasible in haemodialysis patients, with vascular outcomes that are comparable to those of patients who do not require haemodialysis. Nevertheless, patients undergoing haemodialysis have a higher rate of post-operative morbidity and a lower mean rate of survival