Uso de conductos iliofemorales como medida para reducir la morbimortalidad neurológica y vascular en EVAR complejo / Use of iliofemoral conduits to reduce neurological and vascular morbimortality associated with complex EVAR

Introducción y objetivo: la enfermedad oclusiva de las arterias ilíacas puede ser causa de complicaciones en EVAR. Su frecuencia no es muy alta, pero su mortalidad sí y hay evidencia escasa en cuanto a su repercusión en EVAR complejo. el uso de conductos iliofemorales es una herramienta que existe para combatir este problema. el objetivo de este trabajo es analizar el impacto del uso de conductos iliofemorales en la morbimortalidad neurológica y vascular en FeVaR y BeVaR. Materiales y métodos: recolección retrospectiva de pacientes con aneurismas yuxtarrenales, abdominotorácicos o endoleak ia tratados mediante FEVAR o BEVAR de forma electiva entre 2014 y 2020 en una sola institución (la Clínica La Sagrada Familia, Buenos aires, argentina). Se dividieron en dos grupos: uno, con conductos (grupo a), y otros, sin (grupo B). el grupo a se subdividió entre aquellos con conductos temporales y aquellos con permanentes. Resultados: analizamos 45 pacientes. 23 recibieron conductos (grupo a) y 22, no (grupo B). La edad media fue de 73 años y el diámetro promedio del saco fue de 69,89 mm. La estancia hospitalaria media fue de 4,7 días. el grupo a presentó más pacientes con enfermedad vascular periférica (56,5 % frente a 22,7 %, p = 0,045) y diámetros menores de arterias ilíacas externas. Hubo 8 complicaciones en el perioperatorio (17,8 %; grupo a, n = 1, 4,3 %, frente al grupo B, n = 7, 31,8 %; p = 0,043). Fallecieron 2 pacientes, lo que dejó una mortalidad perioperatoria del 4,4 % (grupo a, 0 %, frente al grupo B, 9,1 %; p = 0,45). Las complicaciones incluyeron isquemia medular, ruptura de la arteria ilíaca e isquemia de miembros inferiores. dentro del grupo a, 12 pacientes (52,2 %) recibieron conductos permanentes y otros 11 (47,8 %), temporales. Conclusiones: los conductos iliofemorales en FEVAR y BEVAR son seguros cuando forman parte de la planificación preoperatoria. Las complicaciones neurológicas y vasculares no son infrecuentes y conllevan una alta mortalidad...(AU)

Introduction and objective: occlusive arterial disease involving the iliac arteries can be cause of complicationsin eVaR. its frequency is not high, but its mortality is and there is scant evidence regarding its repercussion incomplex eVaR. the use of iliofemoral conduits is a tool to overcome this problem. our objective is to analyzethe impact of the use of iliofemoral conduits in the neurological and vascular morbimortality associated withFeVaR and BeVaR. Materials and methods: retrospective recollection of patients who underwent elective FeVaR or BeVaR for jux-tarrenal, thoracoabdominal aneurysms or type ia endoleak between 2014 and 2020 in one institution (Clínica LaSagrada Familia, Buenos aires, argentina). Patients were divided in two groups, one with conduits (group a) andone without (group B). Group a was subdivided between those who received temporary conduits and those withpermanent conduits. Results: we analyzed 45 patients. 23 received conduits (group a) whereas 22 did not (group B). mean age was 73years and mean sac diameter was 69.89 mm. mean hospital stay was 4.7 days. Group a presented more patientswith peripheral vascular disease (56.5 % vs. 22.7 %, p = 0.045) and smaller iliac arteries. there were 8 complicationsin the perioperative period (17.8 %; group a, n = 1, 4.3 %; group B, n = 7, 31.8 %. p = 0.043). 2 patients died, leavinga perioperative mortality of 4.4 % (group a 0 % vs. group B 9.1 %, p = 0.45). Complications included spinal cordischemia, iliac artery rupture and lower limb ischemia. in group a, 12 (52.2 %) patients received permanent conduitsand 11 (47.8 %) temporary conduits. Conclusions: the use of iliofemoral conduits in FeVaR and BeVaR is safe when they are part of the preoperativeplanning. neurological and vascular complications are not infrequent and carry a high mortality. the use of conduitsis effective to reduce its incidence and associated mortality.(AU)

Cerebrovascular effects of cilostazol in patients with atherosclerotic disease.

BACKGROUND: Cilostazol is a potent selective inhibitor of phosphodiesterase-3 of proven efficacy in intermittent claudication. It has antiplatelet effect and produces vasodilatation in several vascular territories. This drug has been approved in some countries for the prevention of recurrence of cerebral infarction. Limited data in patients with cerebral infarcts suggest improvement in cerebral blood flow. Dilatation of cerebral vessels with carbon-dioxide challenge can be assessed by transcranial Doppler technique. The percentage increase in blood flow velocity is called cerebral vasomotor reactivity (CVR). OBJECTIVE: In this investigation we sought to measure CVR before and after oral administration of cilostazol. METHODS: We studied patients with risk factors for atherosclerosis before they received cilostazol (100 mg twice daily) for intermittent claudication. CVR was assessed by measuring bilateral middle cerebral artery blood flow velocity during normoventilation and after 3 minutes of breathing 8% carbon dioxide. One average value was obtained from each patient. CVR was measured the day before cilostazol first dose, at 1 month, and 3 to 6 months later. RESULTS: We examined 9 patients (8 men and 1 woman) aged 67.6 +/- 8.4 years. All patients had hypertension, 5 had diabetes, 4 were smokers, 5 had high cholesterol levels, and 4 had coronary artery disease. CVR was 54.4 +/- 14.4% at baseline, and increased to 64.2 +/- 18.6% after 1 month (P < .05) and to 67.1 +/- 13.3% at 3 to 6 months later (P < .01). CONCLUSION: Our findings suggest that cilostazol increases CVR in patients with atherosclerotic disease.