J.A. González-Fajardo

Fístula aortoduodenal primaria: descripción de un caso y revisión de la bibliografía

Resumen Introduccion La fistula aortoenterica primaria es una excepcional, pero devastadora, etiologia de sangrado digestivo. El ser portador de un aneurisma de aorta abdominal constituye el mayor factor de riesgo. La triada clinica clasica es hemorragia digestiva alta, dolor abdominal y masa abdominal pulsatil. La prueba diagnostica con mas utilidad es la tomografia computarizada con contraste intravenoso, a pesar de que la endoscopia se indica en los casos con sangrado digestivo. El tratamiento quirurgico con injerto sintetico in situ es la tecnica de eleccion en casos sin elevado nivel de contaminacion. La reparacion endovascular es una alternativa factible en pacientes seleccionados. Caso clinico Presentamos un caso de fistula aortoenterica primaria en el que se sospecho ruptura inminente de un aneurisma de aorta abdominal con su hallazgo intraoperatorio. Describimos las caracteristicas etiologicas y clinicas, ademas de discutir el algoritmo diagnostico actual y el papel de las nuevas tecnicas endovasculares en su tratamiento.

Impacto ambiental sobre la rotura de aneurisma de aorta abdominal

IMPACTO AMBIENTAL SOBRE LA ROTURA DE ANEURISMA DE AORTA ABDOMINAL Resumen Introduccion. Los factores ambientales habitualmente se han relacionado con la rotura de aneurismas de aorta abdominal (AAA). El objetivo de este estudio es analizar su influencia con la posible estacionalidad y rotura de los AAA. Pacientes y metodos. Se diseno un estudio ecologico retrospectivo estratificado por estaciones utilizando una serie de 106 AAA rotos registrados durante el periodo 2000-2007 y confirmados mediante tomografia computarizada y cirugia. Como variables ambientales se registraron la presion atmosferica, temperatura y humedad relativa al dia de la rotura, asi como la fase lunar correspondiente a ese dia. Todos estos datos fueron facilitados y procesados por el Centro Meteorologico Regional. Resultados. La edad media de la serie fue de 73 anos (rango: 50-91 anos), con un predominio franco de varones (98,1%). La tasa de mortalidad global fue del 58,5%. Mediante un histograma de frecuencias se observo una mayor incidencia de AAA rotos en otono (32,1%). La unica variable que presento diferencias estadisticamente significativas (p

Compresión de la arteria femoral profunda por safena interna aberrante e influencia en el desarrollo de claudicación intermitente

Summary Introduction. The relationship between vascular malformations and the appearance of intermittent claudication is rare. Case report. We describe the case of a 70-year-old male, a smoker, diabetic and dyslipidemic, who visited because of intermittent claudication at short distances with occasional rest pain in both lower limbs. Following a clinical and haemodynamic examination, an arteriographic study was performed. The right common iliac artery was found to be occluded, there was stenosis of both deep femoral arteries at the origins, and bilateral femoral-popliteal obstruction was also observed. After performing a right iliofemoral bypass, a thromboendarterectomy of the left common and deep femoral arteries was carried out. An incidental surgical finding was the unilateral anomalous drainage of the internal saphenous arch in the deep femoral vein, which crossed over the artery of the same name, constricting and displacing it, thus giving rise to a certain degree of fibrosis in surrounding tissue. The arteriotomy showed a severe reduction in the calibre of the arterial lumen at this level, caused by both an increase in the atherosclerotic plaque and the intrinsic compression due to the aberrant situation of the internal saphenous artery. Conclusions. This is the first description of this anatomical malformation in the great inguinal vessels and we were also able to observe directly the probable effect on the morphological and haemodynamic factors of aetiopathogenesis in the arteriosclerotic process and, consequently, in limb ischemia. [ANGIOLOGIA 2004; 56: 587-94]

Estudio de las repercusiones arteriales de la deprivación y aporte de hormonas femeninas. Estudio experimental

Summary Introduction . It has been generally accepted that female hormones protect against the development of cardiovascular diseases and more especially with regard to the development of degenerative disorders affecting the arteries. Aims . This study attempts to show the relationships between the hormonal component and the artery wall, and evaluates them from a histological and morphometric point of view. Materials and methods . We conducted an experimental study in rats using different groups of animals in order to provide an animal model in which to demonstrate the arterial repercussions of the different hormonal situations. The experimental design was structured in a number of study groups based on hormonal deprivation, followed by replacement that was implemented either pharmacologically or by means of ovarian transplant in the wall of the artery. Results and conclusions . The repercussions of hormone deprivation were not seen very clearly, but detection was possible using morphometric methods. Results show that hormone replacement neutralises the possible degenerative effects stemming from hormone deprivation. We discuss the interaction of estrogenic hormones and their involvement in the development of arterial pathologies, and the evidence that exists in the literature on this issue. [ANGIOLOGIA 2004; 56: 529-38]