Endovascular treatment of internal iliac artery aneurysms: single center experience

Abstract Objective: Internal iliac artery aneurysms (IIAA) are rare, representing only 0.3% of aortoiliac aneurysms. Its treatment with open surgery is complex and associated with high morbidity and mortality, which led to increasing application of endovascular solutions. In this study, we aimed to evaluate outcomes of endovascular aneurysm repair (EVAR) of IIAA in one institution. Methods: We retrospectively reviewed all cases of IIAA treated with endovascular techniques between 2003 and 2014. Endpoints were morbidity, mortality, freedom from pelvic ischemic symptoms (buttock claudication, ischemic colitis, and spinal cord injury), and need for reintervention. Results: There were 16 patients, 13 males and 3 females, with mean age of 75.1±7 years. A total of 20 IIAA (4 cases were bilateral), with mean diameter of 37.9 mm, were treated. EVAR was performed in 13 (81.3%) patients, with associated internal iliac artery's outflow occlusion in 2. Iliac branch device was used in one patient. Two patients underwent endovascular IIAA embolization alone. One patient underwent percutaneous, transgluteal, IIAA embolization. IIAA flow preservation in at least one internal iliac artery was possible in 9 (56.3%) patients. Early mortality was 7% (1 case). Early morbidity was 18.8%. Pelvic ischemic complications occurred in 1 (7%) patient with buttock claudication. Late reintervention was needed in 3 patients, none of them for IIAA related complications. Conclusion: Endovascular treatment of IIAA is technically feasible and durable. Although overall morbidity is relatively high, major complications are infrequent and perioperative mortality is low. internal iliac artery flow preservation is technically challenging and, in a significant number of cases, not possible at all.

Desigualdades na autoavaliação de saúde: uma análise para populações do Brasil e de Portugal / Inequalities in self-rated health: an analysis of the Brazilian and Portuguese populations / Desigualdades en la autoevaluación de salud: un análisis para poblaciones de Brasil y de Portugal

Resumo Objetivou-se analisar a prevalência de saúde autoavaliada como ruim, segundo variáveis sociodemográficas e presença de doença crônica, em populações do Brasil e de Portugal. Foram estudados 13.894 indivíduos (≥ 30 anos) das capitais do Nordeste do Brasil (VIGITEL 2011) e 20.579 de Portugal (4o INS 2005/2006). Utilizou-se a Regressão de Poisson para as análises de associação ajustadas por covariáveis. As prevalências brutas de saúde percebida como ruim, para o Nordeste do Brasil e para Portugal, em homens, foram de 4,3% e de 15,5%. A razão de prevalência (RP) foi de 2,72 (IC95%: 2,70-2,74) após a padronização por faixa etária. Para mulheres, as prevalências foram 8,1%, para o Brasil, e 25,1%, para Portugal (RP: 2,40; IC95%: 2,39-2,42). A variável que revelou desigualdades na saúde autoavaliada como ruim, em maior intensidade, foi a escolaridade, em ambas as populações. A presença de doença teve efeito maior nos brasileiros do que nos portugueses, em ambos os sexos. As prevalências de saúde autoavaliada como ruim foram significativamente mais elevadas para Portugal, em todos os agrupamentos estudados.

Abstract The aim of this study was to analyze the prevalence of poor self-rated health according to socio-demographic variables and the presence of chronic diseases in the populations of Brazil and Portugal. A total of 13,894 individuals ≥ 30 years of age were studied in capitals in Northeast Brazil (VIGITEL 2011) and 20,579 in Portugal (4th NHI, 2005/2006). Poisson regression was used in both analyses of associations, adjusted by covariates. Net prevalence rates of poor health in men in Northeast Brazil and Portugal were 4.3% and 15.5%. Prevalence ratio was 2.72 (95%CI: 2.70-2.75) after standardization by age bracket. In women, prevalence was 8.1% in Northeast Brazil and 25.1% in Portugal (PR: 2.40; 95%CI: 2.39-2.42). The variable that showed the worst inequalities in poor self-rated health was schooling, in both Brazil and Portugal. Current disease had a stronger effect on Brazilians than on Portuguese, in both men and women. Prevalence of poor self-rated health was significantly higher in Portugal in all the groups analyzed.

Resumen El estudio tuvo como objetivo analizar la prevalencia de salud autoevaluada como mala, según variables sociodemográficas y presencia de enfermedad crónica, en poblaciones de Brasil y Portugal. Se estudió a 13.894 individuos (≥ 30 años) de capitales del Nordeste de Brasil (VIGITEL 2011) y a 20.579 de Portugal (4º INS 2005/2006). Se utilizó la regresión de Poisson para el análisis de asociación ajustado por covariables. Las prevalencias brutas de salud percibida como mala en hombres, en el Nordeste de Brasil y Portugal, fueron de un 4,3% y de un 15,5% respectivamente. La razón de prevalencia (RP) fue de un 2,72 (IC95%: 2,70-2,74), tras la padronización por franja etaria. Para las mujeres, las prevalencias fueron de un 8,1%, para Brasil y un 25,1%, para Portugal (RP: 2,40; IC95%: 2,39-2,42). La variable que -con mayor intensidad- reveló desigualdades en la salud autoevaluada como mala fue la escolaridad, en ambas poblaciones. La presencia de enfermedad tuvo más efecto en brasileños que en portugueses, en ambos sexos. Las prevalencias de salud autoevaluada como mala fueron significativamente más elevadas para Portugal, dentro de todos los grupos estudiados.

[Inequalities in self-rated health: an analysis of the Brazilian and Portuguese populations]. / Desigualdades na autoavaliação de saúde: uma análise para populações do Brasil e de Portugal.

The aim of this study was to analyze the prevalence of poor self-rated health according to socio-demographic variables and the presence of chronic diseases in the populations of Brazil and Portugal. A total of 13,894 individuals ≥ 30 years of age were studied in capitals in Northeast Brazil (VIGITEL 2011) and 20,579 in Portugal (4th NHI, 2005/2006). Poisson regression was used in both analyses of associations, adjusted by covariates. Net prevalence rates of poor health in men in Northeast Brazil and Portugal were 4.3% and 15.5%. Prevalence ratio was 2.72 (95%CI: 2.70-2.75) after standardization by age bracket. In women, prevalence was 8.1% in Northeast Brazil and 25.1% in Portugal (PR: 2.40; 95%CI: 2.39-2.42). The variable that showed the worst inequalities in poor self-rated health was schooling, in both Brazil and Portugal. Current disease had a stronger effect on Brazilians than on Portuguese, in both men and women. Prevalence of poor self-rated health was significantly higher in Portugal in all the groups analyzed.