Registro de actividades de la Sociedad Española de Angiología y Cirugía Vascular, año 2016 / Register of activities of the Spanish Society of Angiology and Vascular Surgery, 2016

OBJETIVO: describir la actividad asistencial del año 2016 de los servicios/unidades de angiología y cirugía vascular en España. PACIENTES Y MÉTODOS: estudio transversal con encuesta a 107 centros sobre procedimientos quirúrgicos y exploraciones vasculares realizados en 2016. Análisis descriptivo de resultados y comparación de la ratio de actividad / 100 000 habitantes con 2014. RESULTADOS: respondieron 41 servicios, ninguno en la medicina privada. La actividad quirúrgica global en cirugía arterial en 2016 fue semejante a la de 2014, con variaciones en la ratio / 100 000 habitantes según el sector. Hubo un aumento relevante de la tasa actividad en aorta torácica (1,9 frente a 1,1), aorta toracoabdominal (0,49 frente a 0,38) y arterias viscerales (1,8 frente a 1,3). Hubo también un aumento moderado de actividad en los aneurismas de aorta abdominal (10,8 frente a 9,5) y en la patología obstructiva del sector aortoilíaco (13,1 frente a 11,1). Prácticamente en todas ellas la ratio de procedimientos de cirugía convencional fue inferior, mientras que la de cirugía endovascular aumentó en algunos. En 2016 se encontró un aumento relevante en el número de accesos de hemodiálisis (25,3 frente a 20,6). La actividad en amputaciones mayores y menores fue semejante (7,5 frente a 7,3 y 11,6 frente a 10,7). No se encontró diferencia significativa en la actividad global sobre el sector venoso en 2016 con respecto a la de 2014 (66,6 frente a 65,4), si bien hubo un aumento moderado de procedimientos de cirugía endovascular para tratamiento de varices. También se encontró un aumento moderado de la ratio / 100 000 habitantes de exploraciones vasculares (850,6 frente a 760,5). CONCLUSIONES: se encontró un aumento ligero de la actividad quirúrgica arterial global, con un incremento de procedimientos en algunos territorios; la actividad venosa global se ha mantenido, con gran aumento de procedimientos endovasculares para el tratamiento de varices; también se encontró aumento de las exploraciones vasculares. Con relación a 2014, disminuyó de forma considerable la participación, lo que condiciona el sesgo en la interpretación de los datos

OBJECTIVE: to describe the assistant activity of the year 2016 of the services / units of Angiology and Vascular Surgery in Spain. PATIENTS AND METHODS: a cross-sectional study with a survey of 107 centers on surgical procedures and vascular examinations carried out in 2016. A descriptive analysis of results and comparison of the activity ratio/ 100,000 inhabitants with 2014 was performed. RESULTS: forty-one (38.3%) departments of vascular surgery (27 training units, 71%) in Spain answered this survey. None from private medicine. Regarding to these units there were 29,046 admissions, 36.3% being urgent and 63.7% scheduled, with an average stay of 6.7 days. On the waiting list there was a predominance of venous pathology over arterial (5,783 vs. 1,187). The global surgical activity in arterial surgery in 2016 was similar to that of 2014 with variations in the ratio/ 100,000 inhabitants according to the arterial sector: 9.39 vs. 9.35 in supraaortic trunks; 23.5 vs. 21.9 in the femoropopliteal arteries and 10.3 vs. 9.8 in the distal sector. There was a significant increase in the activity rate in thoracic aorta (1.9 vs. 1.1), thoracoabdominal aorta (0.49 vs. 0.38) and visceral arteries (1.8 vs. 1.3). There was also a moderate increase in activity in abdominal aortic aneurysms (10.8 vs. 9.5) and in obstructive pathology of the aorto-iliac sector (13.1 vs. 11.1). Practically in all of them the ratio of conventional surgery procedures was lower, while that of endovascular surgery increased in some. In 2016, a significant increase was found in the number of hemodialysis accesses (25.3 vs. 20.6). The activity in major and minor amputations was similar (7.5 vs. 7.3 and 11.6 vs. 10.7). There was no significant difference in the overall activity on the venous sector in 2016 compared to 2014 (66.6 vs. 65.4), although there was a moderate increase in endovascular surgery procedures for varicose veins. There was also a moderate increase in the ratio/ 100,000 inhabitants of vascular examinations (850.6 vs. 760.5). CONCLUSIONS: a slight increase in global arterial surgical activity was found, with an increase in procedures in some territories. Global venous activity has been maintained, with a large increase in endovascular procedures for the treatment of varicose veins. An increase in vascular examinations was also found. In relation to 2014, participation decreased considerably, which determines the bias in the interpretation of the results

Adventitial cystic disease of radial artery. Apropos of a case and review of literature.

Adventitial cystic disease is an uncommon condition that is characterized by the collection of mucinous material that accumulates in the adventitial layer of the artery. Predominantly, this entity affects the popliteal artery, whereas it is extremely rare in the radial artery. We report a 72-year-old female patient that underwent surgical treatment of an adventitial cyst of the right radial artery. The involved arterial segment was resected, and reconstruction by means of the interposition of a saphenous vein graft was performed. Although the etiology is still debated, the finding of a pedicle through the superficial palmar branch of the radial artery connecting to the adjacent wrist joint reinforces the hypothesis of synovial origin. After 12 months, the patient is asymptomatic, and duplex ultrasound shows no signs of recurrence and patency of the bypass. This rare entity should be suspected when a pulsatile mass is noted in the radial artery because an early diagnosis and appropriate management may prevent further complications.

Fenestrated and chimney endovascular aneurysm repair versus open surgery for complex abdominal aortic aneurysms.

BACKGROUND: Many patients with complex abdominal aortic aneurysms are unfit for open repair. New endovascular technologies and bailout techniques are being used for managing these complex anatomies. The purpose of this study is to compare the results obtained with advanced endovascular aneurysm repair (a-EVAR) techniques (fenestrated and chimney endografts) to those obtained with open repair for the treatment of complex abdominal aortic aneurysms not anatomically suitable for standard endovascular exclusion (infrarenal neck <10 mm, juxtarenal, suprarenal and Crawford's type IV thoracoabdominal aneurysms). METHODS: All patients that underwent open surgery (OS cohort; historical, January 1994-December 2015) or a-EVAR (a-EVAR cohort; prospective, January 2006-December 2015) at our institution for complex abdominal aortic aneurysms that meet the anatomical criteria described above on the preoperatory contrast-enhanced computed tomography scan were included. Vascular Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (V-POSSUM) was employed for risk-assessment. RESULTS: A total of 108 patients were included, all of them male: 56 in the OS cohort and 52 in the a-EVAR cohort (mean age: 67.5±6.7 vs. 72.65±6.4 years, respectively; P=0.000). V-POSSUM predicted 4 deaths for the OS cohort and 3 deaths for the a-EVAR cohorts within the postoperative period and morbidity rates of 57% and a 44.4%, respectively. All-cause 30-day mortality rates were 9 patients (16%) for the OS cohort and 2 patients (3.8%) for the a-EVAR cohort (P=0.038). Thirty-day morbidity rates were 59% for the OS cohort and 44% for the a-EVAR cohort (P=0.09). Mean cost of treatment was € 15,707 per patient for the OS cohort (median: € 11,516; inter-quartilic range [IQR]: € 7901; min-max: € 5069-11,0052) and € 33,457 per patient for the a-EVAR cohort (median: € 29,663; IQR: € 5979; min-max: € 13,865-19,3536), P=0.000. CONCLUSIONS: A-EVAR is a feasible alternative to open surgery for complex abdominal aortic aneurysms at our institution, with lower 30-day mortality rates, yet increasing double the amount the total cost of the therapy.

A Rare Complication After Endovascular Aneurysm Repair: Disconnection of the Suprarenal Stent of a Zenith Endograft.

PURPOSE: To report a disconnection between the bare suprarenal stent and the main body of a Zenith endograft. CASE REPORT: A 79-year-old man with a history of successful endovascular repair of an aortic aneurysm presented a sudden episode of hypotension and hematuria. He had undergone implantation of a Zenith bifurcated device 8 years earlier in 2006. Plain abdominal radiography and computed tomography showed disconnection of the uncovered proximal stent, which led to endograft migration and type Ia endoleak. The patient also presented with distal endoleaks at the attachment sites in both common iliac arteries. The aneurysm sac diameter had increased from 52 to 96 mm. A proximal aortic cuff and bilateral iliac extensions were deployed via a common femoral artery access. Completion angiography did not show endoleak. CONCLUSION: After publication of a few such cases with the older Zenith device, the union between the suprarenal stent and main body was reinforced in 2002 to prevent this complication. Since modification of the device, this sequela had not been described. The reappearance of this complication underscores the need for continued surveillance, considering that these late events may require a reintervention to maintain the clinical success of the procedure.

Mid-Term Outcomes of Endovascular Treatment for TASC-II D Femoropopliteal Occlusive Disease with Critical Limb Ischemia.

PURPOSE: The purpose of the study was to assess the safety and midterm effectiveness of endovascular treatment in Trans-Atlantic Inter-Society Consensus II (TASC-II) D femoropopliteal occlusions in patients with critical limb ischemia (CLI). METHODS: Patients with CLI who underwent endovascular treatment for TASC-D de novo femoropopliteal occlusive disease between September 2008 and December 2013 were selected. Data included anatomic features, pre- and postprocedure ankle-brachial index, duplex ultrasound, and periprocedural complications. Sustained clinical improvement, limb salvage rate, freedom from target lesion revascularization (TLR), and freedom from target extremity revascularization (TER) were assessed by Kaplan-Meier estimation and predictors of restenosis/occlusion with Cox analysis. RESULTS: Thirty-two patients underwent treatment of 35 TASC-D occlusions. Mean age was 76 ± 9. Mean lesion length was 23 ± 5 cm. Twenty-eight limbs (80 %) presented tissue loss. Seventeen limbs underwent treatment by stent, 13 by stent-graft, and 5 by angioplasty. Mean follow-up was 29 ± 20 months. Seven patients required major amputation and six patients died during follow-up. Eighteen endovascular and three surgical TLR procedures were performed due to restenosis or occlusion. Estimated freedom from TLR and TER rates at 2 years were 41 and 76%, whereas estimated primary and secondary patency rates were 41 and 79%, respectively. CONCLUSIONS: Endovascular treatment for TASC II D lesions is safe and offers satisfying outcomes. This patient subset would benefit from a minimally invasive approach. Follow-up is advisable due to a high rate of restenosis. Further follow-up is necessary to know the long-term efficacy of these procedures.