Michel Bergoeing R

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)

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.

Tratamiento endovascular del trauma de aorta descendente

Mortality of traumatic aortic lesions is over 80%. Agroup of those who survive, develop a chronic pseudo aneurism, usually asymptomatic, that isdetected during imaging studies. Since conventional surgical treatment of traumatic aorticlesions has a great mortality, endovascular treatment has been used as an alternative treatmentin the last decade.

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

Aneurisma aórtico abdominal en pacientes mayores de 80 años: tratamiento quirúrgico convencional en 80 casos consecutivos

Background: Abdominal aortic aneurysms (AAA) may be lethal unless appropriately and timely treated. Since age is a surgical risk, octogenarians are usually not considered as candidates for surgical intervention. Aim: To asses surgical complications and mortality in octogenarians treated for AAA. Subjects and Methods: Patients aged 80 years older, treated consecutively between 1984-2001 were retrospectively analyzed. Results: Sixty one patients were male, and their age ranged from 80 to 95 years. All were treated with open surgery. The operation was elective in 58 and as an emergency in 22 patients (symptomatic or ruptured AAA). Aortic diameter was 6.8±1.4 cm in asymptomatic patients and 7.7±1.8 cm in emergency cases (p=0.024). Thirty days postoperative mortality was 5.1% in elective surgery compared to 40.6% in emergency operations (p <0.01). Five years survival rate was 44.7% in asymptomatic patients compared to 10.4% in the emergency cases (p <0.023). Conclusions: Elective surgery for asymptomatic AAA can be performed with low operative mortality in octogenarians. However, surgery in emergency cases has an 8 fold increase in risk. Accordingly, octogenarian patients should be considered for elective AAA repair in a selective basis (Rev Med Chile 2003; 131: 981-6). (Key Words: Aged, 80 and over; Aneurysm, dissecting; Surgical procedures, operative)

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.

Tratamiento endovascular de fístula aorto esofágica secundaria a cáncer de esófago: Caso clínico

Background: Esophageal squamous cell carcinoma can spread locally to neighboring organs in the mediastinum. When it invades the aorta, the patient may develop an aorto esophageal fistula (AEF), complication that carries a high mortality rate. We report a 62-year-old male with stage IV esophageal carcinoma who, after chemo radiation treatment, developed an AEF. He was successfully treated with the use of an aortic endograft. The patient died 13 months later due to progression of his cancer, without evidence of sepsis or new bleeding episodes.Esophageal squamous cell carcinoma can spread locally to neighboring organs in the mediastinum. When it invades the aorta, the patient may develop an aorto esophageal fistula (AEF), complication that carries a high mortality rate. We report a 62-year-old male with stage IV esophageal carcinoma who, after chemo radiation treatment, developed an AEF. He was successfully treated with the use of an aortic endograft. The patient died 13 months later due to progression of his cancer, without evidence of sepsis or new bleeding episodes.

Tratamiento endovascular de la disección aórtica tipo B mediante endoprótesis

Background: Dissections that involve the ascending aorta are classified as type A, regardless of the site of the primary intimal tear, and all other dissections as type B. Type B dissections can have fatal ischemic and hemorrhagic complications. In the chronic state, dilatation and rupture can be mortal. Endovascular surgery is a therapeutic alternative, considering the high rate of complications of conventional surgery Aim: To report the results of endovascular treatment of type B aortic dissection. Material and methods: Report of 36 treated patients (30 males) aged 43 to 87 years, with a type B aortic dissection. Seventy eight percent were hypertensive and 39% smoked. The diagnosis was connrmed by CAT sean. Acute patients were treated for complications and chronic patients, for dilatation. In the operating room, an endoprothesis was placed through the femoral artery, to cover the tear. The tear was located and the lumens were differentiated using angiography and transesophageal echocardiography. Results: All procedures were successful. In 16 acute dissections the indications were malperfusion syndrome or unmanageable hypertension in seven patients and imminent rupture or persistent pain in nine. Twenty chronic patients were operated due to dilatation (mean 6 cm). One patient died due to cardiac failure. One patient had a transient paraparesia and two had pulmonary embolism. No patient died in a follow up period ranging from 2.5 to 74 months. Four patients required a new aortic endovascular procedure due to progressive dilatation or endoleak. Conclusion: Endovascular treatment of type B aortic dissection has good immediate andlong term results

Interrupción de la vena cava inferior mediante filtros de inserción percutánea: Indicaciones y resultados en 287 pacientes

Anticoagulation is the treatment of choice for deep veinthrombosis (DVT) and pulmonary embolism (PE). Occasionally this treatment is contraindicated orfails to prevent PE. In these patients, inferior vena caval (IVC) interruption is indicated and insertionof a filter is the most commonly performed procedure.