RESUMO
La publicación de la primera reparación endovascular de un aneurisma de aorta abdominal ha cumplido 20 años, y los estudios aleatorizados que comparan la cirugía abierta con la endovascular han completado los 10 años de seguimiento.La experiencia en la reparación endovascular ha crecido notablemente, así como su uso ampliado a anatomías complejas mediante endoprótesis estándar en unos casos o con fenestradas y/o ramificadas en otros. El empleo para aneurismas rotos se ha difundido, aunque su uso sistemático para ello cuenta aún con dificultades y diversos puntos de controversia que motivan estudios no aceptados por todos. Las novedades en nuevas endoprótesis son continuas, y actualmente asistimos a un boom de ofertas comerciales, frente a un reducido grupo establecido en el mercado desde hace años que, no obstante, también ha implementado modificaciones que deben demostrar su efectividad a largo plazo. Sociedades científicas internacionales destacadas en el ámbito europeo y mundial han publicado actualizaciones de sus guías entre 2010 e inicios de 2011, en un intento de plasmar la actualidad de un campo tan cambiante.En este momento parece razonable poner al día el documento publicado en el capítulo de Cirugía Endovascular de la Sociedad Española de Angiología y Cirugía Vascular (SEACV), que pretende ser un documento de base que, manteniendo la esencia del original, incorpora novedades, puntos de debate y propuestas razonadas de mejora a partir de las que establecer un acuerdo global en la reparación endovascular de AAA, tanto en aspectos clínicos como técnicos.Por ello las recomendaciones son genéricas, a falta de un consenso explícito y recomendaciones oficiales emanadas de la sociedad científica que nos agrupa(AU)
It is now twenty years since the publication of the first endovascular repair of an abdominal aortic aneurysm, and randomised studies comparing open surgery with endovascular surgery have completed 10 years of follow-up.Experience in endovascular repair has markedly increased, as well its widened use in complex anatomies using standard endoprosthesis in some cases, or fenestrated and/or branched in others. The use for ruptured aneurysms has spread, although its systematic use still for this still has difficulties and several points of controversy due to studies not accepted by everyone. The innovations in new stents are continuous, and we are currently experiencing a boom in commercial offer, due to a reduced group established in the market for years. These, however, have also implemented changes that still are to show their effectiveness in the long term. International scientific groups in Europe and worldwide have published updates of their guidelines between 2010 and the beginning of 2011, in an attempt to reflect the current situation in such a changing field.Up to this point, it seems reasonable to update the document published by the Endovascular Chapter of the Spanish Angiology and Vascular Surgery (SEACV), which attempts to be a reference document, that while maintaining the essence of the original, includes innovations, points for debate and reasoned proposals for improvement, from which to establish an overall agreement on the repair of abdominal aortic aneurysms, in both the clinical and technical aspects.For this reason the recommendations are generic, lack a clear consensus and official recommendations by the Scientific Society to which we belong(AU)
Assuntos
Humanos , Masculino , Feminino , Procedimentos Endovasculares/métodos , Aorta Abdominal/patologia , Aorta Abdominal/cirurgia , Aneurisma/diagnóstico , Aneurisma Aórtico/cirurgia , Aneurisma Aórtico , Stents Farmacológicos/tendências , Stents Farmacológicos , Angiografia/tendências , Angiografia , Procedimentos Endovasculares , Aorta Abdominal/fisiopatologia , Aneurisma/cirurgia , Aneurisma Ilíaco/cirurgiaRESUMO
Introducción. Las alteraciones gastrointestinales a modo de dispepsia, náuseas, diarreas, estreñimiento, úlcerapéptica o hemorragia gastrointestinal son efectos indeseables asociados frecuentemente a los fármacos antiagregantesplaquetarios. Objetivo. Identificar la estrategia terapéutica que se asocia a una mayor reducción de los problemas gastrointestinalesasociados a antiagregantes plaquetarios. Pacientes y métodos. De modo consecutivo, se incluyeron pacientesambulatorios tratados crónicamente con fármacos antiagregantes plaquetarios, que presentaban trastornos gastrointestinalesatribuidos por el investigador al tratamiento antiagregante. Se registraron las estrategias utilizadas para el manejode los trastornos gastrointestinales y se estudió el grado de satisfacción de los pacientes mediante escalas analógicasvisuales de tolerabilidad, calidad de vida y facilidad para el cumplimiento de la medicación, tanto con el tratamiento farmacológicoinicial como con el tratamiento farmacológico instaurado para manejar los trastornos gastrointestinales. Resultados.Se reclutaron 609 pacientes (55,3% hombres). Los pacientes inicialmente tratados tanto con triflusal en solucióncomo con triflusal en cápsulas toleraban mejor la medicación que los inicialmente tratados con ácido acetilsalicílico (p <0,0001). El cambio de tratamiento antiagregante o de dosis fue la estrategia más utilizada (65% de los casos). En 385 pacientes(63,2%) se realizó un cambio de tratamiento farmacológico. El cambio del tratamiento antiagregante inicial portriflusal solución mejoró la tolerabilidad del tratamiento y la calidad de vida, al tiempo que redujo la dificultad para elcumplimiento de la medicación. Conclusión. El triflusal en solución es una buena alternativa en pacientes que presententrastornos gastrointestinales asociados a tratamiento antiagregante crónicoAU)
Introduction. Gastrointestinal disorders like dyspepsia, nausea, diarrhoea, constipation, peptic ulcers or gastrointestinalhaemorrhages are undesirable side-effects that are often associated to antiplatelet therapy. Aim. To identifythe therapeutic strategy that leads to the greatest reduction in the number of gastrointestinal problems associated withantiplatelet drugs. Patients and methods. Our sample consisted of consecutive outpatients undergoing chronic antiplatelettherapy who presented gastrointestinal disorders that the researcher attributed to the antiplatelet therapy. Thestrategies used this to manage the gastrointestinal disorders were recorded and the degree of patients satisfaction wasstudied by means of visual analogical scales for measuring tolerability, quality of life and ease of treatment compliance,for both the initial pharmacological treatment and pharmacological treatment that was established to manage thegastrointestinal disorders. Results. The sample was made up of 609 patients (55.3% males). Patients who were initiallytreated with triflusal solution and with triflusal capsules tolerated medication better than those who were initially treatedwith acetylsalicylic acid (p < 0.0001). Changing the antiplatelet therapy or the doses was the most widely used strategy(65% of cases). Pharmacological treatment was changed in 385 patients (63.2%). Changing the initial antiplatelettherapy for triflusal solution improved treatment tolerability and quality of life, while also lessening the difficultiesinvolved in achieving medication compliance. Conclusions. Triflusal solution is a good alternative in patients whopresent gastrointestinal disorders associated to chronic antiplatelet therapy(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Inibidores da Agregação Plaquetária/efeitos adversos , Gastroenteropatias/induzido quimicamente , Doenças Cardiovasculares/prevenção & controle , Estudos EpidemiológicosRESUMO
No disponible
Assuntos
Humanos , Aneurisma da Aorta Abdominal/diagnóstico , Procedimentos Cirúrgicos Vasculares/métodos , Implante de Prótese Vascular/métodos , Aneurisma da Aorta Abdominal/cirurgia , Complicações Pós-Operatórias , Cuidados Pré-Operatórios/métodos , Diagnóstico por Imagem/métodosRESUMO
Introducción. La disección aguda tipo B de la aorta torácica es una entidad compleja y grave, asociada a una elevada morbilidad y mortalidad. Desarrollo. Tradicionalmente, el tratamiento médico se ha preferido para las disecciones no complicadas, y se ha reservado la reparación quirúrgica para las que presentan complicaciones isquémicas o rotura. El tratamiento endovascular con endoprótesis ha aportado mayores esperanzas para los casos complicados, a la vez que se ha postulado su aplicación en casos asintomáticos. Estos aspectos se revisan y se discuten a fondo en el presente documento. Asimismo, se analizan aspectos técnicos del tratamiento endovascular pertenecientes al pre, peri y posprocedimiento. Conclusión. Por el momento, el uso de endoprótesis sólo está justificado en el tratamiento de disecciones agudas complicadas o inestables, o en las crónicas con expansión aneurismática
Introduction. Acute type B dissection of the thoracic aorta is a complex, severe condition associated to a high rate of morbidity and mortality. Development. Medical treatment has traditionally been preferred for non complicated dissections while surgical repair has been reserved for those with ischaemic complications or rupture. Endovascular treatment with a stent has brought greater hope for complicated cases, and its application in asymptomatic cases has also been suggested. These issues are reviewed and discussed at length in this article. Likewise, technical aspects of the endovascular treatment belonging to the pre-, peri- and post-operative periods are also analysed. Conclusions. For the time being, the use of stents is only justified in the treatment of complicated or unstable acute dissections, or in chronic cases with aneurysmal expansion
Assuntos
Procedimentos Cirúrgicos Vasculares/métodos , Dissecação/métodos , Dissecação da Artéria Carótida Interna/diagnóstico , Dissecação da Artéria Carótida Interna/cirurgia , Isquemia/complicações , Próteses e Implantes , Eletrocardiografia/métodos , Radiografia Torácica/métodos , Aortografia/métodos , Cuidados Pós-Operatórios/métodos , Indicadores de Morbimortalidade , Eletrocardiografia/tendências , Eletrocardiografia , Tomografia Computadorizada de Emissão/métodos , Ecocardiografia Transesofagiana/métodos , Espectroscopia de Ressonância Magnética/métodosRESUMO
Objetivo. Estudiar los cambios morfológicos de la pared aórtica en la disección crónica tipo B de Stanford tratada mediante stents recubiertos. Pacientes y métodos. Fueron tratados 17 pacientes (edad media: 61 años; rango: 35-70 años) por disección crónica tipo B. Se implantaron endoprótesis Talent (n = 11) y Excluder (n = 6); abordaje femoral (n = 15) y retroperitoneal (n = 2); control intraoperatorio mediante fluoroscopia y ecocardiografía transesofágica; cobertura intencionada de la arteria subclavia en cinco casos. Resultados. Éxito técnico con cierre de la puerta de entrada (17/17); tiempo quirúrgico: 73 ± 22 min (rango: 55-160 min); sin conversiones ni paraplejía; estancia postoperatoria media: 48 horas; trombosis de la falsa luz torácica completa (n = 13) y parcial (n = 4). El diámetro mínimo de la luz verdadera (LV) aumentó de 18,1 ± 5,4 a 27,9 ± 5,06 mm (p < 0,01). La luz falsa (LF) se redujo de 39,22 ± 18 a 26,6 ± 12,7 mm (p < 0,01). Seguimiento medio: 18 meses (rango: 1-58 meses); sin migraciones, fugas u otras complicaciones relacionadas con la endoprótesis; tres pacientes necesitaron a posteriori cobertura de la reentrada distal. Conclusiones. El cierre de la puerta de entrada mediante stents recubiertos suele inducir la trombosis en la LF torácica, ello conlleva una remodelación aórtica: estabilización del diámetro aórtico máximo, con cambios estadísticamente significativos del índice LV/LF (reducción de la LF, aumento de la LV). La aorta abdominal suele permanecer inalterada por persistencia de reentradas paraviscerales. Los resultados preliminares sugieren que el tratamiento endovascular de la disección crónica tipo B es una opción terapéutica factible y efectiva, con excelentes resultados a medio plazo
Aim. To study the morphologic evolution in the aortic wall of the chronic aortic type B dissection treated by means of stent-graft. Patients and methods. 17 patients (average age: 61 years; range 35-70 years) were treated by chronic aortic type B dissection. The endoprosthesis implanted were Talent (n = 11) and Excluder (n = 6); femoral access (n = 15) and iliac (n = 2); intraoperative transesophageal ecocardiography; intentionally left subclavian artery coverture in five patients. Results. Closure of the entry tear in all cases; surgical time: 73 ± 22 min (range: 55-160 min); no conversions, no neurological complications; median postoperative length of stay 48 hours; thrombosis of the thoracic false lumen (FL), complete (n = 13) and partial (n = 4). The minimum diameter of the true lumen (TL) increase from 18.1 ± 5.4 to 27.9 ± 5.06 mm (p < 0.01). FL reduction from 39.22 ± 18 o 26.6 ± 12.7 mm (p < 0.01). Mean follow up: 18 months; no related graft complications. In the follow up three patients needed to seal distal thoracic re-entry. Conclusions. The clossure of the entry tear usually induces the thrombosis of the thoracic FL. It promotes a remodelling of the aortic wall consistent in the stabilization of the maximum aortic diameter with significant changes of the index TL/FL (reduction of the LF and increase of the TL). The abdominal aorta usually remains unchanged by persistence of paravisceral reentries. The preliminary results suggest that stent-graft repair of the aortic dissection B type is a feasible and effective therapeutic option with excellent mid-term results
Assuntos
Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Humanos , Angioplastia/métodos , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular , Aorta Torácica/fisiopatologia , Complicações Pós-Operatórias/epidemiologiaRESUMO
No disponible
Assuntos
Humanos , Procedimentos Cirúrgicos Vasculares/história , Procedimentos Cirúrgicos Vasculares/tendênciasAssuntos
Aneurisma/etiologia , Doença Iatrogênica , Punções/efeitos adversos , Punho/irrigação sanguínea , Idoso , Idoso de 80 Anos ou mais , Aneurisma/diagnóstico , Aneurisma/cirurgia , Artérias/lesões , Sangria/efeitos adversos , Cateterismo Periférico/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Laser angioplasty represents an attractive alternative to overcome the limitations of balloon angioplasty. We describe our results with laser thermal balloon angioplasty (LTBA) in the treatment of atherosclerosis obliterans in the lower limbs after two years clinical follow up. We also analyse the influence of lesion characteristics on immediate results. Thirty seven patients (34 men), whose mean age was 58 +/- 9 years, were included in this study. Occlusive arterial disease (Fontaine stage II-IV), with 39 significant haemodynamic arterial lesions were present in all of them. Ankle/brachial Doppler index was O,51 +/- 0,17. Eighteen lesions were located in the iliac area (13 stenoses 2,3 +/- 1 cm of length and 5 occlusions 4,2 +/- 3 cm) and 21 lesions in femoro-popliteal area (5 stenoses 2,6 +/- 2 cm and 16 occlusions 5,7 +/- 3 cm). A percutaneous procedure was used in 38 cases and only in one case a femoral dissection was necessary. The laser source was argon in 26 cases and Nd-YAG in 13. The overall immediate angiographic and clinical success was 85% (89% in iliac lesions and 81% in femoropopliteal lesions; 100% in stenoses and 70% in occlusions). The presence of occlusion (p less than 0,01) and/or calcium (p less than O,05) influenced negatively the immediate results. No major complications were observed. Seven (17%) minor complications occurred, but no emergency surgery was necessary. The ankle/brachial Doppler index after treatment was 0,82 +/- 0,21. Cumulative clinical patency was 91% for successfully treated patients after two years follow up. We conclude that LTBA represents an effective and less aggressive way to treat atherosclerosis obliterans.(ABSTRACT TRUNCATED AT 250 WORDS)