Mario Fava P

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)

Aneurisma de la arteria esplénica: Diagnóstico diferencial y alternativas terapéuticas

Splenic artery aneurysms are rare and occur predominantly in women. Most of them are asymptomatic until rupture. We report a previously healthy 73 year-old woman who presented with non specific symptoms: dyspepsia and constipation. Laboratory tests were normal. Subsequent examinations (ultrasound and CT) showed a large aneurysm of the splenic artery without any sign of rupture. Endovascular treatment remained successfully performed using coil embolization. During a 12-months follow-up period, the patient was asymptomatic and no evidences of complications or splenic infarction were observed on CT scans

Neoplasia colorrectal.: Tratamiento de la obstrucción con endoprótesis metálicas autoexpandibles

Background: Expandable metal stents can be used as a palliative or pre surgical method to decompress obstructing colonic carcinomas. Aim: To assess the effectiveness of these stents in the treatment of obstructive colonic carcinoma. Patients and methods: Expandable metal stents were placed in nine patients with the diagnosis of colorectal carcinoma and with clinical and radiographic signs of intestinal obstruction. Stents were placed under fluoroscopic guidance in nine patients and with endoscopic help in 2. The indications were palliative treatment in 7 and pre surgical decompression in 2 patients. Results: Stent placement was successful in all patients. One patient presented a self limited rectal bleeding after the procedure. Obstruction was relieved in less than 24 hours after the procedure. Conclusion: Expandable metal stent placement is an effective means of relieving intestinal obstruction caused by colorectal carcinoma.

Tratamiento endoluminal de disección aguda complicada en aorta descendente: Comunicación de un caso

Acute dissection of the aorta, although not common, has early and highly lethal complications. The type A dissection is treated with surgery. Patients with type B dissections are treated with surgery if they have complications like rupture, growth or visceral ischemia. Surgery, however, has complications such as spinal cord ischemia. Endovascular grafts have less mortality and complications. We report a 59 years old male patient with a type B dissection complicated with rupture. He was treated successfully with the placement of an endoluminal graft. He was discharged five days after the procedure in good conditions. After one year of follow up, the patient remains asymptomatic (Rev Med Chile 2006; 134: 1024-9). (Key words: Aortic aneurysm, thoracic; Aortic rupture; Blood vessel prosthesis)

Fibrosis Hepática congénita: un espectro clínico variable: Casos clínicos

: Three children presented autosomic recessivepolycystic kidney disease, which was diagnosed before the appearance of liver disease manifes-tations. They presented a more severe liver damage, with a more aggressive clinical course re-quiring use of transjugular intrahepatic porto-systemic shunts (TIPS) or surgical porto-systemicshunts to control portal hypertension. The other two children, in whom the diagnosed was basedon asymptomatic hepatomegaly, had normal renal function and structure with a more benignclinical course.

Tromboembolismo pulmonar con compromiso hemodinámico: Tratamiento con trombólisis farmacológica y fragmentación mecánica. Caso clínico

Pulmonary Embolism (PE) has a wide clinical spectrum. It isimperative to detect patients with a high risk to develop right ventricular failure, because this isthe main cause of death in patients with massive PE. In this group of patients, invasive therapiesto relieve pulmonary obstruction and right ventricle overload should be used as soon as possible.We report a 85 years old male with massive PE treated with pharmacological thrombolysis andmechanical fragmentation with an angioplasty balloon. Pulmonary perfusion improvedsignificantly. Afterwards, systemic anticoagulation was started and an inferior vena cava filterwas installed percutaneously. The patient was discharged in good conditions, five days afteradmission (Rev Med Chile 2005; 133: 1477-82).(

Recanalización percutánea de oclusiones crónicas de arterias ilíacas con instalación primaria de Stent

Background: Percutaneous transluminal angioplasty is a well established treatment method for aorto iliac stenoses. However its success is limited in arterial occlusions and vascular stent placement can improve the results. Aim: To assess the effectiveness of percutaneous revascularization with stent placement in patients with chronic iliac artery occlusions. Patients and methods: twenty six patients (18 male) aged 47 to 82 years, with iliac artery occlusions lasting six or more weeks were treated. Fourteen had involvement of common iliac artery, five had involvement of external iliac artery and seven of both. The occluded segment length ranged from 3.5 to 12 cm. According to the Society of Cardiovascular Surgery/International Society for Cardiovascular Surgery classification, 22 patients had category 1 claudication, 10 were in category 2, 12 in category 3 and two in category 4. Results: A technical success was obtained in 23 patients and clinical success in 21. After the intervention, the anklearm index improved from 0.49 ± 0.12 to 0.88 ± 0.18 (p < 0.001). Permeability after 12 months of follow up was 81% and after 36 months, 65%. Four patients had complications; one had a vascular perforation, two had an acute occlusion and one had an asymptomatic distal embolization. All these were solved using endovascular techniques. Conclusions: Percutaneous revascularization with stent placement is a valid alternative to surgery in selected patients with chronic iliac artery occlusion.

Tratamiento de la ascitis refractaria mediante derivación transyugular intrahepática portosistémica: caso clínico

Approximately, 10 percent of cirrhotic patients with ascites become refractory to medical treatment, a condition that reduces overall survival. TIPS is a therapeutic alternative for the management of refractory ascites. It corrects sinusoidal portal hypertension, becoming a rational and relatively safe therapeutic approach. The most frequent complications of TIPS are the development of hepatic encephalopathy and a high incidence of shunt stenosis or occlusion after one year of follow-up. We report a 43 years old alcoholic cirrhotic male with ascites refractory to medical treatment, that required multiple large volume paracentesis, whose clinical condition deteriorated progressively. A TIPS was successfully placed with a rapid and complete resolution of ascites and marked improvement of his clinical condition. During the ensuing six months the patient remained in excellent conditions, but was lost from follow-up and resumed excessive alcohol intake. Eight months after TIPS placement he had an upper gastrointestinal bleeding and died