Revista de La Sociedad Española de Angiología y Cirugía Vascular

• Homoinjertos arteriales criopreservados:experiencia clínica durante tres años
  Criopreserved arterial homografts:a three-years clinical experience

• Aneurismas de aorta abdominal infrarrenal no rotos:resultados y complicaciones a corto y largo plazo.20 años de experiencia
  Nonruptured infrarenal aortic aneurysm surgery:review of a twenty years experience

• Estudio enzimático de venas arterializadas porfístula arteriovenosa
  Enzymatic study of veins with arterial pressure because ofarteriovenous fistula

• Aneurismas poplíteos trombosados
  Thrombosed popliteal aneurysms

Criopreserved arterial homografts:a three-years clinical experience

SUMMARY:
Objectives: Clinical, hemodinamic and pathologic evaluation of criopreserved arterial homografts obtained by redo-surgery.Methods: Clinical, hemodinamic (duplex), morphologic (TC scan) and pathologic features of criopreserved arterial homografts requiring redo-surgery or occluded were obtained. Grafts were criopreserved with 15% DMSO and stored at -140ºC.Patients: From January 1995 until January 1998, 52 homografts were implanted in 48 patients (mean age 67, range 33-84). Inclusion criteria were: a) lower limb critical ischemia and/or popliteal aneurysm involving infragenicular popliteal artery and requiring distal bypass without internal saphenous vein available; b) arterial infection; c) and angioaccess. Revascularised arteries included femoro-popliteal or distal in 46 cases, aorto-iliac in 5 cases and humeral in one case. ABO compatibility was maintained and inmunosupresive therapy was associated in two cases (cardiac and renal transplant recipients).Results: Mortality was 10%. Patency was 85%, 61.8% and 47.5% at inmediate period, one-year and two-years, respectivelly. Three inmediate graft ruptures were observed. During follow-up three stenosis and three dilatations were recorded. We have pathologic information of 15 grafts; early analysed grafts (<1 month): 1 case with arterial wall structure preservation, 4 cases with cell loss and elastic preservation, 2 cases with acute inflamatory infiltrate; late analysed grafts: 1 case suggestive of chronic graft rejection. The remainder cases showed elastic preservation, cell loss and fibrosis.Conclusions: 1) Criopreserved arterial homografts are a valid choice for distal bypass when there is no saphenous vein available. 2) They may be also an option for angioaccess. 3) Their use must be avoided when abdominal fistula is suspected. 4) Follow-up examinations are needed to detect graft abnormalities and to perform prophylactic procedures. 5) Pathologic features observed in implanted homografts include early cell loss with preservation of elastic structure.
Key words: Homograft; criopreservation; arterial transplantation; critical ischemia; graft infection; arterial infection.

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Aneurismas de aorta abdominal infrarrenal no rotos:resultados y complicaciones a corto y largo plazo.20 años de experiencia

RESUMEN:
La incidencia y prevalencia de los aneurismas de aorta abdominal infrarrenal ha experimentado un aumento progresivo en los últimos años. Por otra parte la cirugía urgente de aneurismas abdominales rotos sigue presentando una alta morbi-mortalidad con un elevado coste socio-económico.En los últimos veinte años fueron intervenidos en nuestro Servicio de forma profiláctica 298 pacientes portadores de aneurismas aórtico abdominal infrarrenal no rotos (98% hombres y 2% mujeres). Dentro del primer mes de postoperatorio murieron 10 pacientes (3,6%). El 3,8% de los pacientes presentaron complicaciones cardiacas, el 8% respiratorias, un 5% dehiscencia de herida quirúrgica, el 3% isquemia aguda de miembros inferiores, 2,7% complicaciones renales, un 1% colitis isquémica, coagulopatía o reintervención por sangrado, y un 0,3% de los pacientes sepsis. Las complicaciones a largo plazo fueron falsos aneurismas anastomóticos o trombosis de rama en un 4,8% e infección de prótesis o fístula aorto-entérica en un 0,9%. Durante el seguimiento a 10 años el 27,9% de los pacientes murió por cardiopatía isquémica, el 19% por enfermedad neoplásica o accidente cerebro-vascular, un 6,9% por hemorragia digestiva o enfermedad infecciosa, y un 4,6% por isquemia mesentérica. El 16,2% murió de causa desconocida. En la actualidad la cirugía profiláctica de aneurismas aórticos infrarrenales representa una alternaiva con una baja morbi-mortalidad que mejora la espectativa de vida de estos pacientes.
Palabras clave: Aneurisma; aorta; infrarrenal; complicaciones.

Nonruptured infrarenal aortic aneurysm surgery:review of a twenty years experience

SUMMARY:
In the last few years the incidence and prevalence of infrarenal abdominal aortic aneurysms has increased. On the other hand, the emergency repair of ruptured abdominal aortic aneurysms still represents an elevated socio-economic cost.In twenty years time have performed 298 prifilactic repairs for patients with unruptured infrarenal abdominal aortic aneurysms (98% males, 2% females). Ten died in the first month after surgery (3.6%). 3.8% presented cardiac complications; 8% respiratory complications; 5% wound complications; 3% lower extremity ischemia; 2.7% renal complications; 1% intestinal ischemia, coagulopathy or bleeding and 0.3% sepsis.The longterm complications were postanastomotic pseudoaneurysms or prosthetic trombosis (4.8%) and infection of the protesis or aortoenteric fistula in 0.9%:In a ten years folow up, 27.9% died of ischemic cardiopaty; 19% of neoplasic disease or cerebro-vascular accident; 6.9% died of digestive hemorrhage or infections disease, and 4.6% of mesenteric ischemia. The 16.2% died of unknown cause.Nowadays the profilactic repair of the infrarenal abdominal aortic aneurysms represents a low morbi-mortality alternative that increases the life span of these patients.
Key words: Aneurysm; aortic; infrarrenal; complications.

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Estudio enzimático de venas arterializadas porfístula arteriovenosa

RESUMEN:
Objetivos: Estudiar los cambios enzimáticos que se producen en las venas con presión arterial (venas arterializadas por fístula arteriovenosa –FAV–) a lo largo de 8 años.Métodos: Se estudia la actividad enzimática en U/ gr. de proteína (x±SD) de las enzimas musculares Lactodeshidro-genasa (LDH), Creatin-kinasa (CK) y Aspartato aminotransferasa (AST) en 20 venas arterializadas del antebrazo extraídas de pacientes con I.R.C. a los que se les realizó una FAV para hemodiálisis. Las muestras se extraían cuando ésta se trombosaba. La actividad enzimática de las venas arterializadas se comparó con venas normales de diferentes regiones del organismo, así como con arterias normales y arterioscleróticas.Resultados: En las venas arterializadas se produce una disminución de LDH y CK respecto a las venas normales, a difeencia de la AST que aumenta en los primeros meses. A partir de 4 años ésta también disminuye. La LDH y CK se comportan de forma similar en venas arterializadas y en arterias normales. La AST en cambio tiene una actividad aumentada en aquéllas.Conclusiones:
– La AST venosa es la única de las enzimas estudiadas por nosotros que aumenta en venas arterializadas, pudiendo ser un marcador de alteraciones estructurales iniciales de la pared venosa.
– La actividad enzimática en venas arterializadas desciende de forma significativa a partir de 4 años.
– El estudio enzimático de venas arterializadas puede servir para evaluar venas protésicas y predecir su permeabilidad.
Palabras clave: LDH; CK; AST; venas arterializadas.

Enzymatic study of veins with arterial pressure because ofarteriovenous fistula

SUMMARY:
Objectives: To study changes in enzyme activities in veins with arterial pressure (arterialized veins caused by arteriovenous fistula - AVF) during an 8-year period.Methods: Activities were measured in U/g protein (x±SD) for muscle enzymes Lactodehidrogenase (LDH), Creatin-kinase (CK) and Aspartate aminotransferase (AST) in 20 veins with arterial pressure in de forearm of patients with chronic renal insufficiency in whom AVF was created for hemodialysis. Samples were taken when a thrombus formed in the fistula. Enzyme activities in veins with arterial pressure were compared with activities in normal veins in different parts of the body, normal arteries and arteriosclerotic arteries.Results: In veins with arterial pressure, LDH and CK were lower than in normal veins, whereas AST was higher during the first months of study. After 4 years AST was also reduced. Activities of LDH and CK showed a similar behavior in veins with arterial pressure and normal arteries. In contrast, AST activity was increased in veins with arterial pressure.Conclusions: Venous AST was the only enzyme with increased activity in arterialized veins, and may be useful as a marker of initial structural alterations in the vein wall. Enzyme activities in veins with arterial pressure was significantly decreased after 4 years. Measurements of enzyme activities in veins with arterial pressure may in the future be an aid to evaluating autologous venous protheses.
Key words: LDH; CK; AST; arterialized veins.

Aneurismas poplíteos trombosados

Thrombosed popliteal aneurysms

SUMMARY:
Objective: Thrombosis of Popliteal Aneurysms is a severe and frequent complication. Adequate management of this pathology is based on diagnosis and treatment. We present our experience in the topic in the last 10 years.Methods: 23 thrombosed aneurysms in 22 patients (21 male, 1 famale), mean age 68. Acute ischaemia (69.5%), distal embolization (13%), severe ischaemia (30.5%). Fibrinolysis: 5 cases (effectiveness: 4.80%). Surgical treatment: 21. Medical treatment: 2. Surgical approach: internal in 18 cases, posterior in 3 cases. Autogenous vein in 15 cases (51.4%), prosthetic graft in 6 cases (28.6%).Results: Inmediate: patency in 18 cases (85.7%), major amputation in 2 cases (9.5%), death in 1 case (4.7%). Long term patency in 12 cases (66.6%), chronic ischaemia in 4 cases (22.2%), major amputation in 1 case (5.5%), 1 case non revisited (5.5%).Conclusions: Duplex scanning allows the diagnosis of thrombosed popliteal aneurysm in the cases of arterial thrombosis at femoropopliteal level. So, quickly fibrinolysis and surgery are possible according to the ischaemic state of the limb.
Key words: Thrombosed Popliteal Aneurysm; Duplex; Fibrinolysis.