Endarterectomía carotídea: resultados y factores pronósticos a corto y largo plazo. La experiencia en el Complejo Hospitalario Universitario de A Coruña (1994-2011)

[Resumen] Objetivos: Determinar los resultados y los factores de riesgo asociados a la morbimortalidad de la endarterectomía carotídea (CEA). Describir los eventos cardiovasculares mayores adversos (MACES) en el seguimiento a largo plazo y las variables asociadas. Material y métodos: Estudio observacional de seguimiento retrospectivo de 416 CEAs. Los eventos estudiados a corto plazo fueron el déficit neurológico, el infarto agudo de miocardio (IAM), la mortalidad y la morbimortalidad global. El evento estudiado a largo plazo fue el MACE. Resultados: El 4.6 % de los pacientes experimentaron déficit neurológico, el 1.9 % un IAM, el 1.9 % fallecieron y el 22.1 % un MACE. Las variables que se asociaron a déficit neurológico fueron: la enfermedad cerebrovascular previa (OR 4.61), el sexo femenino (OR 4.02), la reintervención inmediata por sangrado (OR 3.47) y el score de Halm (OR 2.42). El déficit neurológico (OR 6.21) se asoció con la mortalidad del procedimiento. La insuficiencia renal crónica (OR 4.39), la reintervención inmediata (OR 3.09) y el sexo femenino (OR 2.60) se asociaron con la morbimortalidad. Las variables predictoras de MACES en el seguimiento fueron el score RCR (HR 1.82) y la arteriopatía periférica (HR 1.59). Conclusiones: Las variables enfermedad cerebrovascular previa, sexo femenino, reintervención inmediata por sangrado, score de Halm e insuficiencia renal crónica se asociaron con la morbimortalidad del procedimiento. La enfermedad arterial periférica y el score RCR elevado tienen un efecto independiente para predecir MACES.[Resumo] Obxectivos: Determinar os resultados e os factores de risco asociados á morbimortalidade da endarterectomía carótide (CEA). Describir os eventos cardiovasculares maiores adversos (MACES) no seguimento a longo prazo e as variables asociadas. Material e métodos: Estudo observacional de seguimento retrospectivo de 416 CEAs. Os eventos estudados a curto prazo foron o déficit neurolóxico, o infarto agudo de miocardio (IAM), a mortalidade e a morbimortalidade global. O evento estudado a longo prazo foi o MACE. Resultados: O 4.6 % dos pacientes experimentaron déficit neurolóxico, o 1.9 % un IAM, o 1.9 % faleceron e o 22.1 % un MACE. As variables asociadas a déficit neurolóxico foron: a enfermidade cerebrovascular previa (OR 4.61), o sexo feminino (OR 4.02), a reintervención inmediata por sangrado (OR 3.47), o score de Halm (OR 2.42). O déficit neurolóxico (OR 6.21) asociouse coa mortalidade do procedemento. A insuficiencia renal crónica (OR 4.39), a reintervención inmediata (OR 3.09) e o sexo feminino (OR 2.60) asociáronse coa morbimortalidade. As variables preditoras de MACES foron o score RCR (HR 1.82) e a arteriopatía periférica (HR 1.59). Conclusións: As variables enfermidade cerebrovascular previa, sexo feminino, reintervención inmediata por sangrado, score de Halm e insuficiencia renal crónica asociáronse coa morbimortalidade do procedemento. A enfermidade arterial periférica e o score RCR elevado teñen un efecto independente para predicir MACES.[Abstract] Objective: To determine the outcomes and risk factors associated with the morbidity and mortality of carotid endarterectomy (CEA). To describe the major adverse cardiovascular events (MACES) in the long-term follow-up and their clinical predictors. Methods: Observational retrospective follow-up study with 416 CEAs. The events studied were short-term neurological deficits, acute myocardial infarction (AMI) mortality and overall morbidity and mortality. The long term event was MACE. Results: 4.6 % of patients had a neurological deficit, 1.9 % AMI, 1.9 % died and 22.1 % experienced an MACE. The variables associated with neurological deficit were: history of cerebrovascular disease (OR 4.61), female gender (OR 4.02), immediate reoperation for bleeding (OR 3.47) and Halm score (OR 2.42). The neurological deficit was a predictor for mortality (OR 6.21). Chronic renal failure (OR 4.39 ), immediate reoperation for bleeding (OR 3.09) and female gender (OR 2.60) were predictors of overall morbidity and mortality. The clinical predictors for MACES were the RCR score (HR 1.82) and the peripheral arterial disease (HR 1.59). Conclusions: The variables history of cerebrovascular disease, female gender, immediate reoperation for bleeding, Halm score and chronic renal failure were associated with mortality and morbidity in the procedure. Peripheral arterial disease and high score RCR have an independent effect in predicting MACES

The influence of the socioeconomic status and the density of the population on the outcome after peripheral artery disease

Observational study[Abstract] Background: Low socioeconomic status (SES) and living in a rural environment are associated with poorer health and a higher number of amputations among the population at large. The purpose of this study is to determine the influence of low SES and of the degree of urbanization on the short-term and long-term results of patients after revascularization for peripheral artery disease. Methods: An observational retrospective follow-up study of 770 patients operated on for peripheral artery disease at three university centers in north-western Spain from January 2015 to December 2016. The events studied were Rutherford classification of severity upon admission, direct amputation, amputations in the follow-up period, new revascularization procedures, major adverse cardiovascular events (MACE), and overall mortality. Mean personal income and income of the household associated with the street in which each patient lived and the degree of urbanization in three areas as per Eurostat criteria: densely populated areas, intermediate density areas, and thinly populated areas. Comorbidity, surgical, and follow-up variables were also collected. Descriptive analysis and Cox regression were used. Approval was obtained from the regional ethics committee. Results: Median follow-up was 47.5 months. MACE occurred in 21.5% of the series and overall mortality was 47.0%. Living in a thinly populated area is associated with a lower risk of MACE (adjusted subhazard ratio = 0.60; 95% confidence interval [CI]: 0.39-0.91). Overall survival is lower in intermediate density area patients (adjusted Hazard Ratio = 1.46; 95% CI: 1.07-2.00). The third quartile of mean personal and household income is associated with a higher risk of major amputation at follow-up (adjusted Odds Ratio 1.92, 95% CI: 1.05-3.52 and adjusted Odds Ratio 1.93, 95% CI: 1.0.3-3.61, respectively). Conclusions: Patients who live in a densely populated area run a higher risk of MACE. SES is neither associated with worse outcomes after surgery nor with MACE in long-term follow-up

Endograft limb trimming and resheathing can be an alternative for emergent aortic repair without adequate stent graft availability

Endograft limb trimming can be an easy customization to perform in some emergent setups and when alternative adequate covered stents are lacking. A man aged 74 years presented with aortoenteric fistula and hemodynamic instability years after an aortobifemoral bypass, and a 56-year-old woman was admitted with acute ischemia due to an aortic ulcer-like lesion. In both cases, tabletop deployment and removal of two stents from an Endurant iliac limb (Medtronic, Fridley, Minn), followed by resheathing and deployment, allowed successful repair as a bridging therapy for open surgery. Both patients are alive and without walking impairment 8 and 6 months later, respectively