Endovascular treatment of thoracic aorta injury after spinal column surgery

Producción CientíficaA 61-year-old woman with a history of left dorso-lumbar scoliosis and severe dorso-lumbar kyphosis underwent surgical treatment of a spinal deformity. Surgery was conducted on the patient by performing a dorso-lumbar spinal arthrodesis (T6-L5) by means of the insertion of two longitudinal rods and a number of pedicle-expander screws at different vertebral levels. Following the orthopedic surgery, the patient presented paraparesis of the lower limbs and anemia that required transfusion. In the immediate postoperative period, a noncontrast-enhanced computed tomography (CT) scan was obtained to assess the medullary canal. A deviation of the left screw placed at T6 was detected; this screw projected outward from the vertebral cortex, protruding into the descending thoracic aorta. A contrast-enhanced CT scan showed that the screw had been malpositioned, and the image was highly suggestive of a perforation of the aortic wall, despite a lack of evidence of a peri-aortic hematoma, extravasation of contrast medium, or pleural effusion. The patient remained hemodynamically stable, and the decision was to perform an endovascular repair electively within 24 hours

Percutaneous treatment of liver failure and acute mesenteric ischaemia

Producción CientíficaReport: A 67-year-old man with atrial fibrillation developed acute liver failure due to an embolic occlusion of the CA and SMA, with a severe coagulation disorder. He was successfully managed with percutaneous stent placement and an exploratory laparotomy was not needed. He remains symptomfree 1 year after the procedure, and duplex follow-up showed stent patency. Conclusion: Endovascular techniques in patients with liver failure, no signs of peritonism, early diagnosis and high operative risk seem feasible and should be used if possible, as first-line option

Retrograde Approach for Endovascular Salvage of an Infrapopliteal Vein Bypass

Producción CientíficaEndovascular treatment through femoropopliteal and infragenicular percutaneous transluminal angioplasty, both in native vessels and in bypass salvage, has been an emerging technique in recent years. However, in some cases, a difficult anterograde access in distal occlusions has limited the technical success of this procedure. Combined subintimal arterial flossing with antegradeeretrograde intervention is used as a resource technique to obtain precise recanalization in these cases. Here, we present the case of a retromalleolar access of the posterior tibial artery, based on subintimal arterial flossing with antegradeeretrograde intervention technique, to achieve femoraleposterior tibial bypass salvage

Complicación de la retirada percutánea de un fragmento de cateter mediante triple lazo Goose-neck

Producción CientíficaLa fractura de un reservorio (porth-catheter) colocado en la vena subclavia y la consecuente embolización del fragmento es una entidad rara, pero potencialmente grave1. La mayoría de los casos publicados se han desarrollado como consecuencia del síndrome de pinzamiento costoclavicular2. Existen descritas distintas técnicas para recuperar fragmentos de catéteres, como son la utilización de pinzas de biopsias, cestas de cálculos, guías tip-deflecting o la utilización de lazos3. Estos últimos se han descrito como un método útil, altamente efectivo y sin complicaciones

Reparación endovascular de endoleak

Producción CientíficaLos endoleaks son la complicación más común tras TEVAR. Diferentes procedimientos son empleados para tratar este tipo de fugas, pero la proximidad de arterias vitales dificulta su tratamiento y aumenta el riesgo de complicaciones. Presentamos un caso en el que se empleó la Técnica de Chimenea (Chimney Graft Technique) para tratar un endoleak tipo IA tras TEVAR. Caso Clínico. Se presenta el caso de un varón de 73 años. Intervenido quirúrgicamente de disección aórtica tipo A (esternotomía en dos ocasiones) y de endoprótesis en aorta torácica descendente con oclusión de arteria subclavia izquierda por disección tipo B. Ingresa por presentar endofuga proximal tipo IA a nivel de endoprótesis torácica, evidenciada en angioTAC de control. Dada su elevada comorbilidad, se planteó realizar “Chimney Graft Technique”, mediante colocación de una endoprotesis Gore TAG® a nivel de aorta ascendente y cayado aortico; asociándose una endoprótesis Endurant® desde aorta ascendente a tronco braquicefálico. A ello se le sumó la revascularización de troncos supraaórticos mediante la realización de un bypass carótido-carotídeo derecho-izquierdo. Ausencia de complicaciones postoperatorias. Tras 6 meses postcirugía, el paciente se encuentra asintomático, con permeabilidad de las endoprótesis y del bypass carótidocarotídeo, sin evidenciarse endofugas en angioTAC de control. Borja Merino Díaz, et al. Reparación endovascular de endoleak tipo IA en el arco aórtico mediante endoprótesis paralelas

Tratamiento endovascular en paciente neoplásico con edema y congestión de hemicuerpo superior

Producción CientíficaIntroducción: El síndrome de vena cava su- perior (SVCS) está producido por la dificul- tad del retorno venoso a través de dicho vaso,produciendo clínica general de edema y con-gestión del hemicuerpo superior del organis-mo. Su etiología es neoplásica en la mayoría de los casos. Caso Clínico: Se presenta el caso de un varón de 65 años diagnosticado de carcinoma mi- crocítico de pulmón, que ingresa nuestro ser- vicio por presentar cuadro de edema en escla- vina y disnea, siendo diagnosticado de SVCS. Es tratado primeramente con medidas gene- rales y tratamiento médico, realizándose en los días posteriores tratamiento endovascular con éxito técnico y resolución completa de la clínica de congestión venosa en el primer día postoperatorio. Conclusión: El tratamiento endovascular del SVCS es un procedimiento eficaz y seguro, que proporciona una rápida mejoría en la calidad de vida del paciente y en los síntomas compresivos. El régimen de anticoagulación óptimo debe ser definido

Venographic comparison of subcutaneous low-molecular weight heparin with oral anticoagulant therapy in the long-term treatment of deep venous thrombosis

Producción CientíficaPurpose: The primary objective of this study was to evaluate with venography the rate of thrombus regression after a fixed dose of low–molecular weight heparin (LMWH) per day for 3 months compared with oral anticoagulant therapy for deep venous thrombosis (DVT). Secondary endpoints were the comparisons of the efficacy and safety of both treatments. Methods: This study was designed as an open randomized clinical study in a university hospital setting. Of the 165 patients finally enrolled in the study, 85 were assigned LMWH therapy and 80 were assigned oral anticoagulant therapy. In the group randomized to oral anticoagulant therapy, the patients first underwent treatment in the hospital with standard unfractionated heparin and then coumarin for 3 months. Doses were adjusted with laboratory monitoring to maintain the international normalized ratio between 2.0 and 3.0. Patients in the LMWH group were administered subcutaneous injections of fixed doses of 40 mg enoxaparin (4000 anti-Xa units) every 12 hours for 7 days, and after discharge from the hospital, they were administered 40 mg enoxaparin once daily at fixed doses for 3 months without a laboratory control assay. A quantitative venographic score (Marder score) was used to assess the extent of the venous thrombosis, with 0 points indicating no DVT and 40 points indicating total occlusion of all deep veins. The rate of thrombus reduction was defined as the difference in quantitative venographic scores after termination of LMWH or coumarin therapy as compared with the scores obtained on the initial venographic results. The efficacy was defined as the ability to prevent symptomatic extension or recurrence of venous thromboembolism (documented with venograms or serial lung scans). The safety was defined as the occurrence of hemorrhages. Results: After 3 months of treatment, the mean Marder score was significantly decreased in both groups in comparison with the baseline score, although the effect of therapy was significantly better after LMWH therapy (49.4% reduction) than after coumarin therapy (24.5% reduction; P < .001). LMWH therapy and male gender were independently associated with an enhanced resolution of the thrombus. A lower frequency of symptomatic recurrent venous thromboembolism was also shown in patients who underwent treatment with LMWH therapy (9.5%) than with oral anticoagulant therapy (23.7%; P < .05), although this difference was entirely a result of recurrence of DVT. Bleeding complications were significantly fewer in the LMWH group than in the coumarin group (1.1% vs 10%; P < .05). This difference was caused by minor hemorrhages. Coumarin therapy and cancer were independently associated with an enhanced risk of complications. Subcutaneous heparin therapy was well tolerated by all patients. Conclusion: The patients who were allocated to undergo enoxaparin therapy had a significantly greater improvement in their quantitative venographic score, a significantl

Techniques chirurgicales : traitement endovasculaire de l'aorte thoracique ascendante

Producción CientíficaNous d ecrivons le traitement endovasculaire d’un patient qui, apr es chirurgie de l’aorte thoracique ascendante pour dissection aigu€e de type A (proc ed e de Bentall), a d evelopp e un faux an evrysme de 12 cm de diam etre de l’aorte ascendante au niveau du tronc brachioc ephalique. Dans un premier temps, un pontage carotido-carotidien extra-anatomique a et e fait, suivi d’un traitement endovasculaire, excluant la crosse aortique de l’origine des deux art eres coronaires a l’origine de l’art ere carotide commune gauche, occluant le tronc brachioc ephalique. Pour le placement pr ecis de l’endoproth ese, le dispositif a et e largu e apr es arr^et cardiaque avec de l’ad enosine

Clinical and haemodynamic evolution of lesions treated by means of a therectomy with Silver Hawk in the femoropopliteal sector

Producción CientíficaThe objective of the work is to study the clinical and haemodynamic evolution, over 1 year, in patients with femoropopliteal arterial pathology treated by means of atherectomy with the SilverHawk device. Materials and methods: Nineteen (19) patients were treated between December 2008 and May 2009, collecting data on sex, age, comorbidity and clinical degree, with prospective monitoring over 12 months of clinical symptoms, physical examination and ecodoppler, obtaining results on diameter and peak systolic velocity at different arterial levels. Results: Of the 19 patients, 14 were men and 5 women, with a mean age of 70 years, hypertensive (73%), diabetic (63%) and smokers (63%). Six (6) presented disabling claudication and 13 critical ischemia with advanced distal trophic lesions in 5. A good arteriographic result was obtained in 12 cases, a stent was placed on the superficial femoral artery in 5 due to suboptimal outcome. Contrast extravasation was observed in 2, with femoropopliteal bypass performed and one exclusion with endoprosthesis for repair. In the ecodoppler after 1, 3, 6 and 12 months, a progressive reduction in lumen diameter and peak intraarterial systolic velocity was observed, particularly on the distal superficial femoral artery. After one year, 7 patients (36.8%) were symptom-free, 5 (26.3%) presented mild or moderate intermittent claudication and 1 patient (5.3%) presented localised distal trophic lesion. Four (4) major amputations were performed, in 2 the knee was preserved, there were 3 thromboses due to the procedure, a secondary endovascular procedure was performed in one case and a femoropopliteal bypass in another, and there were 2 non procedure-related deaths. Discussion: atherectomy with SilverHawk achieves an improvement in clinical degree, with a good rate of extremity salvage in patients with critical ischemia. In the first year, the ecodoppler shows evolution of the arteriopathy, without this necessarily meaning a clinical worsening