Estudio prospectivo aleatorizado sobre el impacto del preacondicionamiento isquémico remoto sobre la nefropatía por contraste en pacientes intervenidos de reparación aórtica endovascular / Prospective randomized study on the impact of remote ischemic preconditioning on contrast induced nephropathy in endovascular aortic repair patients

Introducción: el mayor inconveniente del uso de contrastes yodados en la práctica clínica es la nefropatía por contraste, que aumenta la morbimortalidad y los costes hospitalarios. El preacondicionamiento isquémico remoto (PCIR) es una técnica de protección tisular no invasiva que ha demostrado ser capaz de disminuir la afectación renal tras la administración de contraste intravascular. Objetivo: el objetivo principal del estudio es valorar el impacto del PCIR en la incidencia de la nefropatía inducida por contraste en pacientes intervenidos de reparación aórtica endovascular (EVAR). Material y métodos: se incluyeron pacientes intervenidos de EVAR electivo asignados de manera secuencial en grupo control y de preacondicionamiento (C y P, respectivamente). Se analizaron parámetros bioquímicos pre- y posoperatorios (a las 24 y a las 72 horas y a los 30 días). Resultados: el 98,3 % de los pacientes incluidos en el estudio fueron varones, sobre una muestra total de 120 pacientes. La media de edad fue de 73 años (rango: 56-87). La diabetes y la insuficiencia renal crónica preoperatoria (entendida como filtrado glomerular < 60 ml/min) estuvieron presentes en el 29,16 % y en el 38,33 % de los pacientes, respectivamente. La mitad de la muestra recibió preacondicionamiento en el preoperatorio. Un total de 24,17 % pacientes desarrollaron nefropatía a pesar de sueroterapia con o sin preacondicionamiento. En el posoperatorio (24-72 h) el preacondicionamiento no modificó la incidencia de nefropatía, creatinina y urea sérica o tasa de filtrado glomerular (eFG). Sin embargo, a los 30 días el grupo preacondicionado mostró una mejoría significativa de las cifras de creatinina y de ureas séricas (1,46 ± 0,3 frente a 1,03 ± 0,5; p < 0,001; 61,06 ± 27,5 mg/dl frente a 43,78 ± 12,9 mg/dl; p = 0,003) y aumento de eFG (56,37 ± 23,4 ml/min /1,73 m2 frente a 72,85 ± 17,7ml/min/ 1,73 m2; p = 0,004)...(AU)

Introduction: the biggest drawback of using iodinated contrasts in clinical practice is contrast nephropathy, which increases morbidity and mortality and hospital costs. Remote ischemic preconditioning (RIPC) is a non-invasive tissue protection technique that has proven to be able to reduce renal involvement after intravascular contrast administration. Objective: the main goal of this study was to assess the impact of RIPC on the incidence of contrast-inducednephropathy in patients undergoing endovascular aortic repair (EVAR).Material and methods: patients who underwent elective EVAR were included, and then sequentially assigned to the control and preconditioning groups (groups C and p, respectively). Pre- and postoperative hematocrit (at 24, 72 hours, and 30 days) was analyzed. Results: total of 98.3 % of the patients included in the study were men out of a total sample of 120 patients. The mean age was 73 years (range, 56-87). Diabetes and preoperative chronic kidney disease (understood as glomerular filtration rates < 60 mL/min) were present in 29.16 % and 38.33 % of the patients, respectively. Half of the sample received preconditioning in the preoperative period. A total of 24.17 % of the patients developed nephropathy despite fluid therapy with or without preconditioning. At the postoperative period (24 h-72 h), preconditioning did not modify the incidence rate of nephropathy, serum creatinine and urea, or even the estimated glomerular filtration rate (eGFR). However, at the 30-day follow-up the preconditioned group showed a significant improvement in serum creatinine and urea levels (1.46 ± 0.3 vs 1.03 ± 0.5; p < 0.001; 61.06 ± 27.5 mg/dL vs 43 .78 ± 12.9 mg/dL; p = 0.003) and eGFR increase (56.37 ± 23.4 mL/min/1.73 m2 vs 72.85 ± 17.7mL/min/1.73 m2; p = 0.004).Conclusions: RIPC seems effective in alleviating the effects of iodinated contrast on the kidneys of patients...(AU)

Manejo de la enfermedad tromboembólica venosa en la era COVID-19. Recomendaciones del capítulo español de Flebología y Linfología de la SEACV / Management of venous thromboembolic disease in the era COVID-19. Recommendations of the Spanish phlebology and lymphology chapter of the SEACV

Los pacientes infectados por el nuevo coronavirus COVID-19 presentan un riesgo incrementado de enfermedad tromboembólica venosa (ETEV). La presente guía de práctica clínica del Capítulo Español de Flebología y Linfología y la Sociedad Española de Angiología y Cirugía Vascular pretende dar una serie de recomendaciones sobre profilaxis y tratamiento de la ETEV en los pacientes infectados por COVID-19, tanto a nivel hospitalario como ambulatorio, y consejos sobre su seguimiento clínico y ecográfico. Se recomienda que todos los pacientes con infección por COVID-19 hospitalizados, tengan o no factores de riesgo protrombótico asociados, reciban profilaxis antitrombótica, si no existe contraindicación. En caso de pacientes ambulatorios, según perfil clínico e historial médico, se recomienda valorar tromboprofilaxis con heparina de bajo peso molecular (HBPM), en ausencia de contraindicación. Ante el diagnóstico de TVP en paciente con COVID-19, tanto hospitalizado o ambulatorio, debe iniciarse el tratamiento anticoagulante con HBPM a dosis terapéuticas. No existen interacciones farmacológicas descritas de las HPBM con los fármacos empleados contra el COVID-19. Los niveles elevados de dímero-D son un hallazgo común en pacientes con COVID-19, por lo que este parámetro, de forma aislada, no es indicativo para realizar una ecografía Doppler de rutina. Se aconseja la realización de ecografía Doppler a un paciente COVID-19 positivo (con las medidas de protección necesarias) para descartar TVP solo en pacientes con alta sospecha clínica de TVP y cuando se dé una de las dos situaciones clínicas: alto riesgo de sangrado, o que exista un incremento brusco e inesperado de los niveles de dímero-D

Patients infected with the new coronavirus COVID-19 have an increased risk of venous thromboembolic disease (VTEV). The present clinical practice guide of the Spanish Chapter of Phlebology and Lymphology and the Spanish Society of Angiology and Vascular Surgery, aims to give a series of recommendations on prophylaxis and treatment of VTE in patients infected with COVID-19, both at the hospital and outpatient, and advice on their clinical and ultrasound monitoring. It is recommended that all hospitalized patients with COVID-19 infection, whether or not they have associated prothrombotic risk factors, should receive antithrombotic prophylaxis, if there is no contraindication. In the case of outpatients, according to clinical profile and medical history, it is recommended to evaluate thromboprophylaxis with low molecular weight heparin (LMWH), in the absence of contraindication. Given the diagnosis of DVT in a patient with COVID19, both hospitalized and outpatient, anticoagulant treatment with LMWH should be started at therapeutic doses. There are no described pharmacological interactions of HPBMs with the drugs used against COVID19. High levels of D-dimer are a common finding in patients with COVID-19, so this parameter, in isolation, is not indicative for routine Doppler ultrasound. Doppler ultrasound is recommended for a COVID-19 positive patient (with the necessary protective measures), to rule out DVT, only in patients with high clinical suspicion of DVT, and when one of the two clinical situations occurs: high risk of bleeding, or a sudden and unexpected increase in D-dimer levels

Escala Anarcyl (aneurisma de aorta roto de Castilla y León) de predicción de mortalidad de aneurisma de abdominal roto / Anarcyl scale (ruptured aortic aneurysms Castilla y León) for predicting mortality in ruptured abdominal aortic aneurysms

INTRODUCCIÓN: el aneurisma de aorta abdominal roto (AAAr), a pesar de los avances diagnósticos y terapéuticos, continúa presentando una elevada mortalidad. Aunque la reparación endovascular (EVAR) incrementa el número de pacientes a los que se le ofrece tratamiento quirúrgico, no se encuentra exento de complicaciones. OBJETIVO: diseñar una escala de riesgo preoperatorio para los pacientes con AAAr intervenidos mediante EVAR. MATERIAL Y MÉTODOS: estudio prospectivo de 34 pacientes intervenidos mediante EVAR de AAAr en Castilla y León entre junio de 2016 y junio de 2019. Se recogieron variables de comorbilidad, preoperatorias de estabilidad hemodinámica y analítica al ingreso, así como de morbimortalidad intrahospitalaria. RESULTADOS: la mortalidad intrahospitalaria fue del 52,9%. El estudio univariante obtuvo como factores pronósticos de mortalidad la frecuencia cardíaca, la hemoglobina, la creatinina, el sodio, la GOT, la LDH y la troponina T ultrasensible. Tras la realización del estudio multivariante, resultaron significativas la frecuencia cardíaca (p = 0,011), la hemoglobina (p = 0,035) y la creatinina (p = 0,019). La escala resultante ofreció la siguiente fórmula de mortalidad: 0,440 + 0,560 (si hemoglobina < 7 mg/dl) + 0,169 (si frecuencia cardíaca < 70 latidos/min) + 0,084 (si creatinina > 2,8 mg/dl). El área bajo la curva del presente modelo asciende a 0,870 (Fig. 1). Una puntuación ≤ 0,440 se asoció con una mortalidad del 39,1%; una puntuación entre 0,441-0,644, con el 66,7%, y del 100%, si ≥ 0,644. CONCLUSIÓN: la frecuencia cardíaca al ingreso y los niveles analíticos de hemoglobina y creatinina constituyen factores predictores de mortalidad intrahospitalaria en pacientes con AAAr tratados mediante exclusión endovascular. La aplicación de la escala propuesta en el presente estudio permite conocer a los pacientes que no se beneficiarían del tratamiento quirúrgico endovascular del AAAr

INTRODUCTION: the ruptured abdominal aortic aneurysm (AAAr), despite diagnostic and therapeutic advances, continues to present a high mortality. Although endovascular repair (EVAR) increases the number of patients who are offered surgical treatment, it is not without complications.OBJECTIVE: design a preoperative risk scale for patients with AAAr treated by EVAR.MATERIAL AND METHODS: prospective study of 34 patients undergoing EVAR of AAAr in Castilla y León between June 2016 and June 2019. Comorbidities, preoperative variables of hemodynamic stability, analytical at admission, as well as in-hospital morbidity and mortality were collected. RESULTS: in-hospital mortality was 52.9%. The univariate predictors obtained were heart rate, hemoglobin, creatinine, sodium, GOT, LDH and ultrasensitive troponin T as prognostic factors. After completing the multivariate analysis, heart rate (p = 0.011), hemoglobin (p = 0.035) and creatinine (p = 0.019) were statistically different between the groups. The scale resulting from the following mortality formula: 0.440 + 0.560 (if hemoglobin < 7 mg/dl) + 0.169 (if heart rate < 70 beats/min) + 0.084 (if creatinine > 2.8). This model obtained an area under the curve of 0.870 (Fig. 1). A score < 0.440 is associated with a mortality of 39.1%, a score between 0.441-0.644 with 66.7% and 100% if > 0.644. CONCLUSION: the heart rate at admission and the analytical levels of hemoglobin and creatinine, are predictive factors of in-hospital mortality in patients with AAAr treated with endovascular exclusion. The application of the proposed scale allows the detection of patients who would not benefit from the endovascular surgical treatment of AAAr

Estudio nacional de cohortes COVID-VAS / Cohort national study COVID-VAS

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¿Es atractivo ser angiólogo y cirujano vascular en 2020? / Is it attractive to be angiologist and vascular surgeon in 2020?

No disponible

Enfermedad arterial periférica: la influencia de la etnia / Peripheral arterial disease: influence of ethnicity

INTRODUCCIÓN Y OBJETIVO: se han descrito diferencias en la prevalencia de la enfermedad arterial periférica (EAP) en distintas áreas geográficas. El objetivo es analizar los pacientes de Europa del este intervenidos en nuestro centro de isquemia crónica de extremidades inferiores y compararlos con los de origen español para describir cómo puede influir la etnia en el desarrollo de la EAP. MATERIALES Y MÉTODOS: se ha escogido una muestra de 337 pacientes intervenidos en nuestro centro desde el 2007 hasta el 2017 diagnosticados de isquemia arterial crónica de extremidades inferiores. Se han analizado los factores de riesgo cardiovascular (FRCV), la clínica al ingreso, las lesiones TASC y la estancia hospitalaria media. RESULTADOS: los pacientes de Europa del este representan el 7,7% de la muestra. La media de edad es de 67,9 años y un 79,8% son varones: el 70% presenta HTA; el 45,4%, DM; el 52,5%, DLP y el 40,7% son fumadores. Respecto a las comorbilidades, el 30,6% presenta cardiopatía isquémica; el 13,6%, EPOC y un 7,4%, accidentes cerebrovasculares. Los pacientes de Europa del este son más jóvenes (53,5 ± 10,53 frente a 69,09 ± 10,77; p = 0,0001), con menor prevalencia del resto de FRCV (HTA 30,7% frente al 73,3%, p = 0,001; DM 23,07% frente a 47,27%; p = 0,017; DLP 30,77% frente al 54,34%; p = 0,021). La prevalencia de fumadores es mayor (80,77% frente a 69,45%; p = 0,002). Presentan una clasificación Rutherford menor y un ITB más alto (3,19 ± 0,85 frente a 3,73 ± 1,19, p = 0,03, y 0,41 ± 0,21 frente a 0,26 ± 0,06, p = 0,028, respectivamente). La mayoría de los pacientes de Europa del este son claudicantes y presentan una estancia media superior que los pacientes claudicantes de origen español (12,31 frente a 6,3 días; p < 0,001). No existen diferencias significativas en el grado TASC. CONCLUSIONES: los pacientes de Europa del este intervenidos de isquemia arterial crónica de extremidades inferiores son más jóvenes, más fumadores y con menor prevalencia del resto de FRCV. La mayoría presenta claudicación intermitente y tiene una estancia hospitalaria media más elevada que los pacientes españoles

INTRODUCTION AND OBJECTIVE: differences in the prevalence of peripheral arterial disease (PAD) have been described in different geographical areas. These differences have been justified by life habits and socio-economic development of a country. The aim of this study is to analyze eastern Europe patients and Spanish patients, who underwent surgical procedures of lower limb chronic ischemia, to describe how can influence ethnicity in the PAD development. MATERIALS AND METHODS: a sample of 337 operated patients of lower extremities chronic ischemia in our center from 2007 to 2017 has been chose. Cardiovascular risk factors (CVRF), clinic at the beginning of admission, TASC lesions in imaging tests and hospitalization days were analyzed. RESULTS: eastern Europe patients represent 7.7% of the sample. The average age is 67.9 years (22-97) and 79.8% are males. 70% have HTA, 45.4% DM, 52.5% DLP and 40.7% are smokers. Regarding comorbidities: 30.6% have ischemic heart disease, 13.6% OCPD and 7.4% cerebrovascular disease. Eastern Europe patients are younger than Spanish patients (53.5 ± 10.53 vs. 69.09 ± 10.77) and with a lower prevalence of the rest of CVRF (HTA 30.7% vs. 73.3%; DM 23.07% vs. 47.27%; DLP 30.77% vs. 54.34%). In addition, the prevalence of smokers is higher (80.77% vs. 69.45%). They also present a lower Rutherford classification and a higher ABI (3.19 ± 0.85 vs. 3.73 ± 1.19 and 0.42 vs. 0.26, respectively). The average stay is higher in claudicants eastern Europe's patients (12.31 vs. 6.3 days). CONCLUSIONS: operated eastern European patients of lower limb chronic ischemia are young patients, smokers, and have a lower prevalence of the rest of CVRF. More than half of eastern Europe patients present intermittent claudication and they have a higher hospital stay than claudicant Spanish patients

Radioprotection Measures during the Learning Curve with Hybrid Operating Rooms.

BACKGROUND: Endovascular procedures come with a potential risk of radiation hazards both to patients and to the vascular staff. Classically, most endovascular interventions took place in regular operating rooms (ORs) using a fluoroscopy C-arm unit controlled by a third party. Hybrid operating rooms (HORs) provide an optimal surgical suit with all the qualities of a fixed C-arm device, while allowing the device to be controlled by the surgical team. The latest studies suggest that an operator-controlled system may reduce the radiation dose. The purpose of the present study is to determine the amount of absorbed radiation using an HOR in comparison with a portable C-arm unit and to assess whether the radioprotection awareness of the surgical team influences the radiation exposure. The primary end point was the effective dose in milliSievert (mSv) for the surgical team and the average dose-area product (ADAP) in Gray-meters squared (Gym2) for patients. METHODS: The values of absorbed radiation of the surgical team's dosimeters were collected from January 2015 to May 2016. The HOR was installed in June 2015, and a radioprotection seminar was given in October 2015. The HOR-issued radiation, measured by the maximum dose-area product, ADAP, average dose (AD) per procedure, maximum dose per procedure per month, maximum fluoroscopy time, average fluoroscopic time, peak skin dose, and average skin dose (ASD), was collected monthly from September 2015 to July 2016. The timeline was divided into 3 periods: 5 months pre-HOR (Pre-HOR), 5 months after the HOR installation (PreS-HOR), and 5 months after a radioprotection seminar (PostS-HOR). RESULTS: The average number of procedures per month was 22.55 (±4.9), including endovascular aneurysm repair/thoracic endovascular aneurysm repair, carotid, visceral, and upper and lower limb endovascular revascularization. The average amount of absorbed radiation by the surgeons during PreS-HOR was 1.07 ± 0.4 mSv, which was higher than the other periods (Pre-HOR 0.06 ± 0.03 mSv, P = 0.002; PostS-HOR 0.14 ± 0.09 mSv, P = 0.000, respectively). The ADAP during PreS-HOR was 0.016 ± 0.01 Gym2, which was lower than the PostS-HOR (0.001 ± 0.002 Gym2) (P = 0.034). The AD during PreS-HOR was 0.78 ± 0.3 Gy and 0.39 ± 0.3 Gy during PostS-HOR (P = 0.098). The ASD during PreS-HOR was 0.40 ± 0.2 Gy and 0.20 ± 0.1 Gy during PostS-HOR (P = 0.099). CONCLUSIONS: In our experience, the HOR increases the amount of absorbed radiation for both patients and surgeons. The radioprotection seminars are of utmost importance to provide a continued training and optimize the use of ionizing radiation while using an HOR. Despite the awareness of the surgical team in the radioprotection field, the amount of absorbed radiation using an HOR is higher than the one using a C-Arm unit.

[Incidence of contrast induced nephropathy in patients who underwent an aortic endovascular repair]. / Incidência De Nefropatia Induzida Por Contraste Em Pacientes Operados De Reparação Aórtica endovascular.

INTRODUCTION: Intravascular iodinated contrasts are essencial in endovascular therapy. One of their major inconveniences is contrast-induced nephropathy (CIN), which has been associated with an increase in complications and prolonged hospital stay. AIM: To analyze the incidence of CIN in patients undergoing endovascular aneurysm repair (EVAR) in our hospital. MATERIAL AND METHODS: A retrospective study including patients (n=129) treated with EVAR between January 2014 - September 2015. Information was gathered concerning age, history of diabetes, hypertension, pre-existing chronic kidney disease and previous treatment with diuretics or metformin. We analyzed serum levels of urea, creatinine, sodium, potassium and glomerular filtrate (GF), at baseline, at 24hours, peak levels during post-operative period and before discharge. The amount of intravascular contrast and periprocedureral hydration were correlated to creatinine and GF to determine their effect on CIN. RESULTS: Of 129 patients, 11 (8.53%) developed CIN. A significant difference was found between preoperative and postoperative levels of urea and sodium, both p<0.001.Volume of contrast was the only variable that presented a statistically significant association with increase of creatinine levels in postoperative period (p=0.032). Worsening of glomerular filtrate showed a statistically significant association with preoperative levels of urea (p=0.036) and GF (p= 0.019). Fluid-therapy before or after exposure to contrast did not show any influence on the outcome. CONCLUSIONS: The incidence of CIN depends mainly on baseline GF and amount of contrast, and it is barely associated with hydration during the perioperative period. Since there is no specific treatment for CIN, the best practice is its prevention.

Aneurysmal degeneration of brachial artery in kidney transplant receptors after arteriovenous fistula ligation.

OBJECTIVES: True brachial artery aneurysms are. Recent case reports have suggested aneurysmal degeneration of brachial artery in kidney transplant receptors after arteriovenous fistula (AVF) ligation. We present a study on the evolution of the brachial artery in this context in our center. MATERIAL AND METHODS: This is a descriptive study in kidney transplant receptors in whom AVF was ligated between 2008 and 2015. Patients with AVF in both upper limbs were excluded. Diameters of axillary artery, brachial artery in middle portion and its bifurcation, as well as brachial artery flow were measured using Dupplex ultrasound in AVF and contralateral limb. Both groups were compared using the Student t-test for paired samples. RESULTS: 20 patients were included in the study and had a mean age of 59.35 ± 2.49 years. The median time of use of AVF for hemodialysis was 729 days (range 120-6117) and the median time in which AVF was patent was 2261 days (range 791-7091). Mean diameters (in mm) of axillary artery, brachial in middle portion and bifurcation were respectively 9.33 ± 1.07, 7.5 ± 0.61 and 5.81 ± 0.43 in AVF arm and 5.6 ± 2.8, 4.4 ± 0.1, 4.9 ± 0.15 in control limb, finding statistically significant differences (p <0.01) in brachial and axillary arteries. 5 patients (25%) developed aneurysm, 2 of which (10%) underwent surgery and 3 are on follow up. CONCLUSION: True incidence of brachial artery aneurysm in kidney receptors following AVF ligation is high. Careful follow up with physical examination and dupplex scanning are needed to find this complication.

Open surgical repair and endovascular treatment in adult coarctation of the aorta.

BACKGROUND: The aim of this study was to compare the results of endovascular therapy (covered stenting) with surgical technique to repair aortic coarctation in adults. METHODS: A prospective study of 11 patients who were treated during the past 10 years was carried out. Of these, five patients underwent endoprosthesis (group A) and six an open surgical repair (group B). Follow-up comprised monitoring of the blood pressure, echocardiography, and computed tomography and magnetic resonance angiographic studies. RESULTS: The mean age of the patients was 46 years (range: 17-67 years) and the mean follow-up was 52.6 months (range: 1-117 months; 32.3 for group A vs. 69.7 for group B; p = 0.01). Two cases in group A were recoarctations after child angioplasty. The rate of postoperative complications was 27.7% (one hemothorax for group A vs. one pneumothorax and one hemothorax for group B); however, mortality did not occur. The success rate of the endovascular technique was 80%. The stay in the intensive care unit was 2.3 days with significant differences (one group A vs. three group B; p = 0.01), whereas length of hospital stay was 11 days (7.8 group A vs. 11.83 group B; p = 0.17). The pressure gradient across the stenosis decreased by 21.9 ± 3.7 mm Hg (24.5 ± 4.3 group A vs. 33 ± 3.2 group B). Six patients (54.5%) showed persistent hypertension (80% group A vs. 33% group B), with a mean residual pressure gradient of 23.4 ± 4.3 mm Hg (22.5 ± 5.4 group A vs. 22 ± 2.1 group B; p = 0.58). CONCLUSIONS: Short- and medium-term results of the endovascular therapy are similar, with shorter stay in the intensive care unit and higher necessity of antihypertensive treatment. Echocardiography and Doppler aortic coarctation gradients slightly higher than 20 mm Hg are usual during follow-up.

Femoral pseudoaneurysms post-cardiac catheterization surgically treated: evolution and prognosis.

OBJECTIVES: To analyze the postoperative complications of patients who have undergone surgical repair of femoral pseudoaneurysm after cardiac catheterization. DESIGN: Prospective study. MATERIALS: Cardiovascular risk factors, related to surgery and cardiac catheterization were collected prospectively in 79 patients from 2003 to 2006 in Valladolid University Hospital. The indications of surgery included necrosis of adjacent soft tissue, rapid growth, infection, bleeding, hemodynamic instability or failure of the percutaneous treatment (US-guided compression and US-guided percutaneous thrombin injection). METHODS: Patient and management related predictors for 30-day outcome were analyzed. RESULTS: Fifty-six patients (56/79, 71%) experienced some type of postoperative complication, the most frequent being the need for a transfusion. Infection (15/79, 19%) and dehiscence of the surgical wound (10/79, 12.7%) were the other two most common complications. The mortality related to the intervention was 3.8% (3/79). The mean hospital stay was 32.5 days (+/-28.4 days). Significant risk factors in logistic regression model were gender (P=0.023, OR=9.66), 70 years old (P=0.049, OR=0.15) and the concurrent use of anticoagulation or antiplatelet therapy after the cardiac catheterization (P=0.005, OR=0.03). CONCLUSION: Patients who undergo surgical treatment of femoral pseudoaneurysm post-cardiac catheterization experience a high postoperative morbidity and hospital stay. Factors such as female gender, age over 70 years and treatment with anticoagulants or antiplatelets increase the postoperative morbidity. A seasonal influence was appreciated, with a higher frequency during the summer period.

Valor diagnóstico de la ecografía Doppler color en el control clínico de la reparación endovascular de los aneurismas de aorta abdominal / The diagnostic value of colour Doppler ultrasonography in the clinical monitoring of endovascular abdominal aortic aneurysm repair

Introducción. El control clínico del tratamiento endovascular de la enfermedad aneurismática de la aorta abdominal se basa en la valoración de la evolución del tamaño del aneurisma, la permeabilidad de la endoprótesis y la detección de fugas. Objetivo. Comparar la ecografía Doppler (ED) color con la tomografía axial computarizada (TAC) en la evaluación del tamaño del aneurisma y la detección de fugas en el tratamiento endovascular de aneurismas de aorta abdominal. Pacientes y métodos. Estudio prospectivo entre enero y diciembre de 2005. En 14 pacientes sometidos a tratamiento endovascular se realizó ED color y TAC a 1, 6 y 12 meses. Se compararon los tamaños del aneurisma mediante la prueba t para muestras dependientes y estudio de correlación. Sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo y el coeficiente de concordancia kappa se calcularon para la detección de fugas. Resultados. El control clínico medio fue de 9,4 meses y se compararon 49 exploraciones. El diámetro medio del aneurisma a los tres meses de control clínico fue de 51,2 cm con ED color y de 52,5 cm con TAC (p = no significativo). El coeficiente de correlación ascendió a 0,97 (p < 0,001). Todos los dispositivos se mantuvieron permeables. En detección de fugas, el estudio ED color obtuvo una sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo de 75, 61, 20 y 95%, respectivamente (kappa = 0,61). Conclusiones. El estudio ED color obtiene una excelente correlación con la TAC en la medida del tamaño de los aneurismas. En cambio, posee un valor predictivo positivo muy bajo para la detección de fugas

Introduction. Clinical monitoring of the endovascular treatment of aneurysmal disease of the abdominal aorta is based on evaluating the progression of the size of the aneurysm, the patency of the stent and the detection of leaks. Aim. To compare colour Doppler ultrasonography (DU) with computerised axial tomography (CAT) for evaluating the size of the aneurysm and the detection of leaks in the endovascular treatment of abdominal aortic aneurysms. Patients and methods. A prospective study between January and December 2005; colour DU and CAT scans were conducted in 14 patients submitted to endovascular treatment at 1, 6 and 12 months. Sizes of the aneurysms were compared by means of the t test for dependent samples and correlation studies. Sensitivity, specificity, predictive positive value and predictive negative value and the kappa coefficient of agreement were calculated for leak detection. Results. The mean period of clinical monitoring was 9.4 months and 49 examinations were compared. The mean diameter of the aneurysm at three months’ clinical monitoring was 51.2 cm with colour DU and 52.5 cm with CAT scanning (p = non-significant). The correlation coefficient was 0.97 (p < 0.001). Patency was maintained in all the devices. In the detection of leaks, the results of the colour DU study for sensitivity, specificity, predictive positive value and predictive negative value were 75, 61, 20 and 95%, respectively (kappa = 0.61). Conclusions. The colour DU study correlates very well with CAT in the measurement of the size of aneurysms. In contrast, it has a very low predictive positive value for the detection of leaks

Efecto de la trombosis carotídea en el comportamiento hemodinámico de la estenosis contralateral: criterios para su determinación / The effect of carotid thrombosis on the haemodynamic behaviour of contralateral stenosis: criteria for its determination

Objetivo. Comparar la precisión diagnóstica de varios parámetros hemodinámicos en la graduación de la estenosis carotídea en pacientes con oclusión contralateral. Pacientes y métodos. Se diseñó un estudio prospectivo de 76 pacientes con oclusión carotídea unilateral, en el que se correlacionaron de manera ciega los hallazgos de eco- Doppler color y arteriografía. Cada carótida se clasificó, según el grado estenótico angiográfico, en: 1-29% (n = 39), 30-49% (n = 15), 50-69% (n = 14), >= 70% (n = 8). Se consideraron cinco criterios hemodinámicos para valorar una estenosis > 50%: Universidad de Washington (estándar); AbuRahma (pico de velocidad sistólica, PSV > 140 cm/s; velocidad diastólica final, EDV 140 cm/s; EDV 1,5; y método nuevo (ratio de la ICA/CCA > 1,3; PSV > 115 cm/s). Se calcularon la sensibilidad, la especificidad, los valores predictivos positivo y negativo, el valor diagnóstico y el índice de concordancia κ. Resultados. La mejor concordancia arteriografía/eco-Doppler se dio para el método nuevo (κ = 0,59), con una precisión diagnóstica del 84,2, seguida del método estándar (que obtuvo una κ = 0,53 y una precisión de 82,8). Los métodos específicos para pacientes con trombosis carotídea unilateral (AbuRahma y Fujitani) fueron los menos eficaces, mientras que el método de la ratio presentó resultados intermedios. Conclusiones. La presencia de oclusión produce una sobreestimación o infraestimación del grado estenótico ipsilateral según los criterios clásicos admitidos. Este problema puede reducirse mediante la utilización de una ratio > 1,3 y un PSV > 115 cm/s. Para evaluar el grado de progresión de la enfermedad carotídea cada laboratorio ha de validar sus propios criterios, los cuales deben permitir diferenciar entre lesiones hemodinámicamente significativas y aquellas que no lo son (AU)

Aim. To compare the accuracy of various duplex hemodynamic criteria in grading ipsilateral carotid stenosis in patients with contralateral occlusion. Patients and methods. A prospective study was designed with 76 patients who had unilateral carotid occlusion, the results of duplex were correlated in blind fashion to arteriography. Each carotid was classified in order to the angiographic stenotic grade in: 1-29% (n = 39), 30-49% (n = 15), 50-69% (n = 14), ≥ 70% (n = 8). Five duplex ultrasonography classification criteria for discriminate > 50% stenosis were used: Washington University (standard), AbuRahma (peak systolic velocity, PSV > 140 cm/s; diastolic velocity, EDV 140 cm/s; EDV 1.5; new method (ratio ICA/ CCA > 1.3; PSV > 115 cm/s). The sensibility, specificity, positive predictive value, negative predictive value, accuracy and κ index were calculated. Results. Best concordance between angiography and duplex was for the new method, providing a κ = 0.59 and an accuracy of 84.2, followed by standard method that obtained κ = 0.53 and an accuracy of 82.8. Specific methods for patients with unilateral occlusion of ICA (AbuRahma and Fujitani) provided inferior efficacy in detecting carotid stenosis >= 50%, although the ratio method obtained intermediate results. Conclusions. The fact of having a contralateral occlusion of the ICA produces some overestimation or underestimation of the ipsilatral carotid stenosis degree following the classic criteria. This problem can be reduced using a ratio > 1.3 and a PSV > 115 cm/s. Each laboratory should perform an objective evaluation of their own criteria of diagnosis to discriminate hemodynamically significant lesions (AU)