Influence of Interhospital Transfer on Outcomes of Symptomatic and Ruptured Abdominal Aortic Aneurysms.

INTRODUCTION: Symptomatic or ruptured abdominal aortic aneurysms (rAAA) maintains a high mortality index despite technical advances in its treatment. The influence of patients' geographic location on rAAA outcomes, when the rupture occurs or when the AAA becomes symptomatic, has not been a commonly studied issue. Due to the lack of research on this matter, the impact of interhospital transfer on mortality is ambiguous. OBJECTIVE: Evaluate the influence of the geographic location of patients with symptomatic AAA or rAAA on AAA mortality. METHODS: Retrospective review of all cases of symptomatic AAA and rAAA submitted to surgery in a tertiary institution, between January 2011 and August 2017. The main outcome was in-hospital mortality. Secondary outcomes were admission to intensive care unit (ICU), length of ICU and hospital stay, type of repair and anesthesia and weekend presentation. Data was submitted to univariable analysis and logistic regression. Statistical significance was considered if the p value was <0.05. RESULTS: During the defined period of 80 months, a total of 135 patients were admitted with the diagnosis of symptomatic or rAAA and submitted to surgery. Most patients had a ruptured AAA (90.4%, n=122), while symptomatic AAA represented a minority (9.6%, n=13). All patients (91.1% male gender, mean age 74±10 years) were submitted to surgery, 83 (61.5%) by endovascular repair and 52 (38.5%) by open repair, 30.4% with local anesthesia and sedation (n=41), all in the endovascular group. 92 patients (68.1%) were transferred from other hospitals, with a mean distance of 113±88 km. In this cohort, in-hospital mortality was 31.5% in transferred patients and 34.9% in not transferred patients. Subgroup analysis revealed that there were no significant differences between transferred and not transferred patients' groups concerning main outcome (p=0.35), baseline characteristics (age and gender), type of surgery and anesthesia, weekend presentation, ICU admission, length of ICU and hospital stay. Logistic regression analysis revealed that the variables associated with mortality were female gender (odds ratio [OR] 2.28; 95% confidence interval [CI] 1.40-3.70; p<0.01), open repair (OR 2.79; 95% CI 1.68-4.63; p<0.01) and general anesthesia (OR 9.16; 95% CI 2.33-36.06; p<0.01). CONCLUSION: Our study revealed that transfer of patients for urgent repair of AAA was not associated with an increased mortality. The hypothetical increased mortality due to transfer might have been compensated by endovascular treatment and local anesthesia in some cases. Further studies must be carried out, particularly comparing endovascular and open repair in emergency setting.

Ovarian hyperstimulation syndrome as a rare cause of acute bilateral limb and renal ischemia.

Ovarian hyperstimulation syndrome (OHS) is a rare and potentially fatal condition, particularly when it is associated with arterial thromboembolic events. We present a case of acute ischemia of both lower limbs and left kidney due to OHS. The clinical presentation included voluminous ascites, pleural effusion, and significant ovarian enlargement. Subsequently, bilateral severe acute limb ischemia and left kidney segmental infarction were established. Surgical thromboembolectomy and muscle débridement of the lower limbs were necessary, and the patient recovered with partial limitations. A high index of suspicion and timely treatment are essential to minimize consequences of arterial thrombosis associated with OHS.

Bridging thoracic endovascular aneurysm repair for a late rupture following aortic coarctation angioplasty.

UNLABELLED: Introduction Thoracic endovascular aneurysm repair has been employed to treat late complications after aortic coarctation correction. However, its use in children has seldomly been reported. Case report We present the case of a 15-year-old child who presented with a ruptured aneurysm of the descending aorta complicated later by an aortic-oesophageal fistula following aortic coarctation stenting that was managed with multiple bridging endovascular interventions until a definitive repair was performed. CONCLUSION: Thoracic endovascular aneurysm repair may be used successfully as a bridging intervention to a definitive repair in children with life-threatening aortic complications following aortic coarctation repair.

A mycotic forearm pseudoaneurym as an unusual complication of infective endocarditis.

INTRODUCTION: Mycotic pseudoaneurysms are an infrequent complication of infective endocarditis; most cases are secondary to arterial trauma. The commonest site involved are the intracranial arteries, followed by the abdominal aorta and then the peripheral vessels. CASE PRESENTATION: We report a case of a 36-year-old man, admitted in our institution for a subarachnoid haemorrhage, who presented with fever of unknown origin during his stay in the neurocritical care unit and whom was diagnosed infective endocarditis due to Meticilin Sensible Staphylococcus Aureus. Almost two weeks after antibiotic therapy was instituted, he presented a large, growing, pulsatile mass of the left forearm. A giant pseudoaneurysm arising from the radial artery was detected with ultrasound and surgical intervention was carried out. A large laceration of the radial artery was detected and an interposition of a vein graft was performed. DISCUSSION: Forearm mycotic pseudoaneurysms are rare. A high index of suspicion is needed and they should always be borne in mind in the differential diagnosis of an extremity pain, swelling or motor-sensorial deficit after infective endocarditis.

[Buerger's disease: current concepts]. / doença de Buerger: conceitos actuais.

Buerger's disease or thromboangiitis obliterans is a non atherosclerotic, segmentar inflammatory vasculitis that reaches small and medium size vessels of the limbs's extremities. It affects predominantly young male smokers that present distal ischemia, clinically manifested through claudication, rest pain, ulcers and gangrene. A hundred years after its original description by Leo Buerger, the disease's etiology remains unclear, but it is acknowledged the importance of tobacco's role for the initiation, progression and prognosis of the pathology. Its incidence has globally declined, despite the relative increment of female cases owing to the crescent number of smoking women. The treatment has suffered a considerable evolution, manifested by the decreasing number of performed amputations, but it should always be followed by complete interruption of the smoking habits - the central attitude of the therapeutics. The introduction of the antagonists of cannabinoid like rimonabant, revealed promising in helping pacients stop smoking. Prostanoids are nowadays an important therapeutic attitude. Sympathectomy and omental transfer are included as surgical therapeutic options. The recent evolution in the discovery of new therapeutic resources in the angiogenesis scope, have opened up new possibilities for the treatment of Buerger's disease, considered one of the least treatable vasculitis.