Leopoldo ariné M

Frecuencia de aneurisma aórtico abdominal en población adulta con factores de riesgo conocidos

Background: The incidence of abdominal aortic aneurysms has increased. Its predisposing factors are smoking, high blood pressure and dislipidemia. Progressive aneurysmal enlargement may lead to its rupture, which is associated to a mortality rate above 80%. Aim: To assess the prevalence of abdominal aortic aneurysms in Chilean subjects with cardiovascular risk factors. Subjects and methods: Through announcements in open media we invited individuals aged over 60 years, who smoked, had hypertension and/or had occlusive arterial disease, to participate in a study that included medical history and physical examination. An aortic ultrasound was performed in all subjects in whom the aorta was not palpable or there was a suspicion of dilatation. Aortic diameter over 3 cm was considered aneurysmal. Results: Three hundred fifty six subjects aged 67.1±6.7 years, (73.9% males), were evaluated. The study group included 62% hypertensives, 39% with abnormal lipids and 46% smokers. Known coronary heart disease or peripheral arterial diseases were present in 14% and 10%, respectively. Ultrasound was required in 159 subjects. Aneurysms were detected in 21 persons (5.9%), 7.6% in males and 1.1% in females. The mean transverse diameter of the aneurysm was 4.1 cm (3-7.5). Aneurysm was found in 2.3% of subjects younger than 65 years and 8.3% of subjects aged over 65 years. Conclusions: In this sample the prevalence of abdominal aortic aneurysms was 5.9%, affecting predominantly males, with a notorious increase with advanced age (Rev Med Chile 2003; 131: 741-7)

Tratamiento endovascular del aneurisma de aorta torácica descendente

Background: The natural history of aneurysms ends in rupture and death. In 1990 the first endovascular exclusion of an aneurysm, using an endoluminal graft implanted through the femoral arteries was performed. More recently, the same procedure has been used for aneurysms of the thoracic aorta. Aim: To report our experience with endovascular treatment of thoracic aorta aneurysms. Material and methods: Analysis of 14 patients (nine male), aged 30 to 79 years, treated between May 2001 and August 2002. Results: The mean diameter of the aneurysms was 6.9 cm. The etiology was atherosclerotic in nine patients. The Excluder device (Goreâ) was preferentially used. There was no operative mortality or paraplegia. One patient had a transient leg monoparesis that reverted completely. No patient had type I endoleaks. Two patients had type II endoleaks on discharge, that sealed spontaneously. In a follow up, ranging from 2 to 17 months, one patient died of a bronchopneumonia and no aneurysm rupture has been detected. Conclusions: The short term results of endoluminal treatment of thoracic aorta aneurysms are excellent. This treatment is less invasive and has less complications than conventional surgery (Rev Med Chile 2003; 131: 617-22)

Tumor del cuerpo carotídeo: A propósito de 10 casos tratados

A fluid coupling includes a socket and a plug and is used to connect two fluid hoses, whereby the plug has a neck that can be inserted into the socket with an annular groove for engaging with a locking element. The locking element includes a push-button that can be activated in a radial manner from the exterior of the socket and from which two flexible fork arms protrude that engage into a hub of the socket and have diagonal ramp surfaces on the two opposing inner faces of the fork arms, whereby the diagonal ramp surfaces engage around the neck in the area of the annular groove around a part of the circumference of the neck. The annular groove is delimited by two opposing and diverging diagonal surfaces.

Tratamiento endovascular de aneurisma aórtico abdominal: resultados en 80 pacientes consecutivos

1.0 cm in diameter, were treated. The surgical risk of 38% of patients wasgrade III according to the American Society of Anesthesiologists classification. Each procedure wasperformed in the operating room, under local or regional anesthesia, with the aid of digitalsubstraction angiography. The endograft was deployed through the femoral artery (83.7% bifurcated,16.3% tubular graft). A femoro-femoral bypass was required in 11.3% of cases. Follow-up included aspiral CT scan at 1, 6 and 12 months postoperatively, and then annually.

Transección traumática aguda de la aorta torácica: Tratamiento endovascular

Traumatic rupture of the aorta has a near 80% mortality. Most patients die on the site of the accident. Conventional surgical repair of these lesions has a high morbidity and mortality, generally associated to the severity of associated lesions. Over the last decade, endovascular treatment has become an effective therapeutic alternative. We report a 40 years old male, that suffered a traumatic rupture of the descending thoracic aorta in a car accident. A successful endovascular repair was performed, installing an endoprothesis on the site of the lesion, using a femoral artery approach. The patient had a good postoperative evolution and was discharged from the hospital once complete rehabilitation of his associated lesions was obtained (Rev Med Chile 2003; 131: 309-13).

Aneurisma roto de aorta torácica descendente: tratamiento endovascular

In 1991, a technique to exclude aortic aneurysms from circulation inserting an endoluminal graft through the femoral artery, was described. This procedure, usually used for elective abdominal aneurysms, can also be used in the thoracic aorta. We report a 41 years old male with a Marfan syndrome, presenting with a descending aorta aneurysm that ruptured to the mediastinum and pleural cavity. He was compensated hemodynamically and an endovascular stent-graft was deployed at the ruptured zone, through the femoral artery. The postoperative evolution of the patient was uneventful. This technique will allow a less invasive treatment of ruptured aortic aneurysms (Rev Med Chile 2001; 129: 1439-43)

Pseudoaneurisma traumático de troncos supra-aórticos: tratamiento endovascular. Casos clínicos

The traditional treatment of traumatic lesions of the aortic arch branches requires extended surgical exposures, not exempt of morbidity and mortality. Over the last decade, devices that allow a minimally invasive treatment, have been developed. The vessel can be repaired without direct exposure, using an endovascular procedure. We report three patients with traumatic pseudoaneurysms of the left subclavian, brachiocephalic and left common carotid arteries, respectively. All lesions were successfully repaired with the insertion of an endograft. Although long term results of these procedure are unknown, repair of a future stenosis or occlusion is less complicated than the treatment required by the original lesion. Endoluminal repair appears as a safe, efficient and less invasive treatment for these lesions. (Rev Med Chile 2002; 130: 1027-32)

Manejo del aneurisma de la aorta abdominal: Estado actual, evidencias y perspectivas para el desarrollo de un programa nacional

Resumen de la evidencia 1. Los resultados clinicos iniciales de CE son mejo-res. La mayoria de los estudios confirman menormorbimortalidad, permanencia en unidad de tra-tamiento intensivo, necesidad de transfusiones yestada hospitalaria global para CE 12,13,17 .2. El beneficio de menor morbimortalidad de laCE respecto a CA es solo inicial, ya que en elmediano plazo las curvas de sobrevida seequiparan. En el estudio EVAR-1 la mejorsobrevida inicial a 30 dias en pacientes trata-dos con CE no se traduce en una mayorsobrevida posterior (4 anos). Igualmente, lamejoria inicial de la calidad de vida se pierdeantes del primer ano de seguimiento 14 . Elestudio DREAM mostro similares resultados: ados anos la tasa de sobrevida fue de 89,7%para CE y de 89,6% para CA (P =0,86). Lasmuertes atribuibles al AAA fueron de 5,7%para CA y de 2,1% para CE (P =0,05), ladiferencia de 3,7% fue explicada de igualmanera al atribuirse solamente a la ventaja dela mortalidad perioperatoria inicial y no a unposterior beneficio del CE

Terapia endovascular en el sindrome de vena cava superior: caso clínico

The treatment of superior vena cava syndrome is usually oriented to the underlying cause, that can be too slow in emergency cases. We report a 49 years old woman with a multiple myeloma that was admitted due to a superior vena cava syndrome caused by a central venous catheter used for chemotherapy for 20 weeks. She was successfully treated with thrombolysis, angioplasty and stent placement. The patient died 7 months later due to the underlying disease. Long term catheters are the responsible for 20 to 30% of superior vena cava syndromes. Endovascular treatment of the syndrome is successful in 60 to 100% of cases with a symptomatic relapse in 4 to 45% of patients. (Rev Med Chile 2001; 129: 421-6)

Filtros de vena cava inferior en posición suprarrenal

Inferior vena cava (IVC) filters are used to preventmassive pulmonary embolism in cases where anticoagulation is contraindicated or has failed. Itis usually implanted below the renal veins. In a few cases it is necessary to deploy the filterabove them, with theoretical risk of secondary renal failure.