La cirugía en enfermedad aortoiliaca. ¿tiene un lugar en la era endovascular? / Surgery in aortoiliac disease. do you have a place in the endovascular era?

INTRODUCCIÓN: La enfermedad aorto iliaca con clasificación TASC II tipo C deja abierta las alternativas para manejo Endovascular vs cirugía abierta. El seleccionar la mejor estrategia ayuda a disminuir la morbimortalidad. OBJETIVOS: Presentar nuestra experiencia en el tratamiento de pacientes con enfermedad aorto iliaca. MÉTODOS: De julio 2017 a julio del 2018 se realizó una revisión de expediente en busca de enfermedad aorto iliaca TASC II tipo C encontrando 7 pacientes. RESULTADOS: La edad promedio 61.7 años, con un rango promedio de 46 a 70 años, 71% del sexo femenino y 29% masculino, antecedentes de diabetes mellitus 3 (43%) y 4 (57%) con hipertensión arterial, tabaquismo en 6 pacientes que corresponde al 86%, en todos los pacientes estaba presente claudicación intermitente, en 5 pacientes (72%) lesiones necróticas en las extremidades inferiores. Obteniendo una mejoría en relación a su toma inicial de 0.18 MPD y 0.14 para MPI, ningún paciente requirió reintervención no hubo casos de oclusión del injerto. Solo se observaron dos complicaciones menores con un éxito técnicos a los 6 meses de seguimiento post quirúrgico. CONCLUSIONES: La cirugía abierta en enfermedad aorto iliaca TASC II lesiones tipo C puede ser una estrategia terapéutica viable, definitiva y menos costosa

BACKGROUND: Iliac aorto disease with TASC II type C classification leaves open alternatives for endovascular vs open surgery management. Selecting the best strategy helps reduce morbidity and mortality. OBJECTIVES: Present our experience in the treatment of patients with iliac aorto disease. METHOD: From July 2017 to July 2018, we treated 7 patients with TASC II Type A Aortoiliary disease. On admission, we performed a clinical history, assessment of the degree of claudication, palpation of pulses of the lower extremity, description of the type of necrotic lesions in the foot, ankle / arm index shot and Angio 3D tomography study. Patients with aorto iliac type A, B and D lesions were excluded. Open surgery was performed with bifurcated aorto-iliac or aorto-bi-femoral aortic graft, the follow-up was given by the external consultation, ankle / arm index monitoring, improvement of the claudication and limitation of the area of necrosis. RESULTS: The average age was 61.7 years, with an average range of 46 to 70 years, 71% of the female sex and 29% male, a history of diabetes mellitus 3 (43%) and 4 (57%) with hypertension, smoking in 6 patients corres-ponding to 86%, intermittent claudication was present in all patients, in 5 patients (72%) necrotic lesions in the lower extremities. The average ankle /arm index before and after surgery for right leg 0.62 to 0.8 respectively and for left leg 0.58 to 0.72. Obtaining an improvement in relation to its initial intake of 0.18 MPD and 0.14 for MPI, no patient required re-intervention and there were no cases of graft occlusion. Only two minor complications were observed with a technical success at 3 months post-surgical follow-up. CONCLUSIONS: Open surgery in aorto iliaca disease TASC II type C lesions can be a therapeutic strategy when selecting the right patient. Hybrid treatments; open surgery and endovascular are allowing better results so it is important not to abandon this technique in our patients

Impact of optimal anticoagulation therapy on chronic venous ulcer healing in thrombophilic patients with post-thrombotic syndrome.

OBJECTIVE: Post-thrombotic syndrome (PTS) is the long-term sequelae of deep venous thrombosis (DVT). PTS clinical manifestations include chronic leg pain, oedema, lipodermatosclerosis and ulcers. The objective of this study is to determine in patients with documented history of thrombophilias and DVT whether the number of previous thrombotic events and optimal anticoagulation therapy are associated with the time to venous ulcer healing following the start of compression therapy. METHOD: Retrospective analysis performed in thrombophilic patients under the age of 50 years old with chronic venous ulcers secondary to DVT at the wound clinic in the National Institute of Medical Sciences and Nutrition 'Salvador Zubirán ' in Mexico City. Variables such as the number or episodes of thrombotic events, type of hypercoagulable disorder, optimal anticoagulation therapy with Warfarin monitored by therapeutic International Normalised Ratio (INR) (2-3) and compliance to compression therapy were examined. Patients that underwent superficial or perforator vein interruption or endovascular recanalisation of deep veins were excluded from the study. RESULTS: From a database of 29 patients with chronic venous ulcers followed in our clinic from January 1992 to September 2012, only 13 patients (61% female) met the inclusion criteria. Mean age±standard deviation (SD) was 32±12 years old. Of these, seven (54%) patients with suboptimal INR presented with an average of two previous thrombotic events and the remaining six (46%) patients with optimal INR only one event (p=0.28), the mean time to the clinical manifestation of a venous ulcer after the first episode of DVT was 39 months (range: 12-72) for patients with suboptimal INR and 82 months (range: 12-216) for those with optimal anticoagulation therapy (p=0.11). During the mean follow-up period of 52 months, all patients in optimal anticoagulation healed their ulcer; their mean time for wound healing was 44 months (range: 4-102). In the suboptimal INR group, only four healed the ulcers with an mean of 72 months (range: 2-204) (p=0.94). CONCLUSION: There seems to be an association between an optimal anticoagulation therapy with Warfarin monitored by INR and wound healing rates in thrombophilic patients with chronic venous ulcers. Further research is warranted. DECLARATION OF INTEREST: The authors have no conflict of interest.