Search

A prolonged operative time (OT) is a well-recognized risk factor of postoperative complications after many open surgical procedures, although little is known about its impact in less invasive endovascular procedures. We aimed to define the characteristics related to a prolonged OT in the endovascular treatment of aorto-iliac aneurysms (EVAR) and to evaluate the influence of OT on postoperative outcomes.Retrospective analysis of 284 consecutive patients (mean age 75 years, 95% male) who underwent an elective EVAR between 2000 and 2019. Operative characteristics related to OT and the impact of OT in postoperative results were studied using multiple lineal and logistic regression analyses, respectively.The mean surgical time was 200 minutes. OT was associated (regression model) with the implantation of straight endografts (-38 minutes, p=0.007), femoral artery surgery (+ 80 minutes, p0.001), hypogastric preservation procedures (+ 70 minutes, p0.001), associated peripheral arterial disease (+22 minutes, p=0.013), general anesthesia (+34 minutes, p0.001) and aneurysm diameter (+9 minutes/cm, p=0.002). During the postoperative period (30 days or at discharge), 21% presented a complication and 2.8% died. OT was independently associated with a higher incidence of postoperative complications (OR for each additional 30' of surgery=1.34, p0.001), immediate (OR=1.48, p=0.003) and 6-month mortality (OR=1.28, p=0.025).A prolonged OT is an independent risk factor for complications and mortality after EVAR. Surgeons must take this factor into consideration when defining the best therapeutic strategy for abdominal aortic aneurysms.

Multiple CT-derived measurements of sarcopenia have been described yet their relationship with survival after abdominal aortic aneurysm (AAA) repair has not been properly assessed. We aimed to define and compare the relationship between several psoas CT-derived measurements and the 5-year survival after AAA repair and to evaluate their potential contribution to survival prediction.Preoperative CT area (TPA) and density (MTPD) of the psoas muscle at L3 were measured in 218 consecutive AAA patients electively intervened. Additional measurements were obtained by normalizing TPA by anthropometric data or L3-vertebra surface or by TPAxMTPD multiplication (lean psoas muscle area-LPMA). The association of sarcopenia markers with survival was evaluated with Cox models adjusted by age, sex, type of intervention and the Charlson Comorbidity Index, and their contribution to survival prediction assessed with the C-statistic and the Continuous Net Reclassification Index (c-NRI).Sixty patients (27.5%) died during the first 5 years after surgery. There was a statistically significant and linear (spline analysis) relationship of sarcopenia markers with 5-year survival in all multivariate models, except that including LPMA. Despite this association, the inclusion of sarcopenia markers did not improve the C-statistic and moderately increased the c-NRI. None normalized sarcopenia markers performed better than TPA.The majority of CT-derived psoas muscle measurements of sarcopenia showed a significant and independent relationship with survival after elective AAA repair. Despite this association, they did not appear to improve sufficiently our survival prediction ability to become an efficient tool for decision-making.

As a result of the increasing life expectancy of the western population, the number of older patients with chronic limb-threatening ischemia (CLTI) seeking medical care is growing. Our objective was to describe the characteristics of a consecutive series of nonagenarian patients with CLTI and evaluate the outcomes of their management.Retrospective analysis of a consecutive series of nonagenarian patients with CLTI attended at our institution between 2005 and 2019. Primary endpoints were 1-year limb salvage and survival rates.A total of 171 patients were included (mean age 92.7, 51.5% women), of which in 59 (34.5%) primary major amputation (n = 10) or palliative care (n = 49) was indicated at presentation because of severe dementia (n = 30, 50.8%), knee retraction (n = 17, 28.8%), terminal condition (n = 13, 22%) or a non-salvageable foot (n = 28, 47.4%). In the remaining 112 (65.5%), the need for a revascularization was further assessed finally performing A) conservative treatment/minor amputation (n = 57, 50.9%), B) revascularization (n = 50, 44.6%) or C) direct major amputation (n = 5, 4.4%), with 1-year limb salvage and survival rates of 93.1 and 57.4%, respectively. Predictive factors for lower survival included age gt;92 years (HR = 1,59, p = 0.041), hemoglobin lt;10.5 mg/dL (HR 2,34, p lt; 0.001), congestive heart failure (HR = 1.65, p = 0.036), non-severe dementia (HR 3,11, p lt; 0.001) and current mobility with wheelchair (HR 1,74, p = 0.014).Nearly one-third of nonagenarian patients with CLTI have a direct indication for amputation or palliative care at presentation. In the remaining, a judicious approach with conservative treatment, minor amputation or revascularization procedures yields excellent limb salvage rates. Survival is, however, the cornerstone of these patients. It can be predicted with certain clinical factors which may help decision-making.

Resumen Introduccion y objetivos La denervacion renal es una intervencion percutanea para el tratamiento de la hipertension arterial resistente. Estudios aleatorizados han mostrado resultados contradictorios sobre su eficacia. Se presentan los resultados de un registro de denervacion en pacientes con hipertension resistente segun practica clinica en Espana. Metodos Registro multicentrico de pacientes consecutivos con hipertension arterial resistente tratados con denervacion renal en Espana en el periodo 2009-2018. Resultados Se ha incluido a 125 pacientes (media de edad, 56 ± anos; el 41% mujeres; media de 14 ± 9 anos de evolucion de la hipertension). La presion arterial sistolica y diastolica en la consulta y ambulatoria de 24 h disminuyeron a los 6 meses de la intervencion (de 166 ± 20/95 ± 16 a 149 ± 22/87 ± 16 mmHg y de 151 ± 14/89 ± 12 a 143 ± 15/84 ± 11; ambas, p Conclusiones La denervacion renal en pacientes con hipertension resistente se relaciono con una disminucion de las cifras de presion arterial en la consulta y, lo que es mas importante, en la monitorizacion ambulatoria de presion arterial, con una disminucion significativa del tratamiento farmacologico.

Introduction and objectives: Renal denervation is a percutaneous intervention for the treatment of resistant hypertension. Randomized studies have shown contradictory results on its efficacy. We present the results of a renal denervation registry for the treatment of resistant hypertension in real-life patients in Spain. Methods: Multicenter registry of consecutive patients with resistant hypertension treated with renal denervation in Spain between 2009 and 2018. Results: We included 125 patients (mean age, 56 years; 41% female; mean onset of hypertension 14 +/- 9 years previously). Office systolic and diastolic blood pressure and ambulatory blood pressure monitoring decreased 6 months after the intervention (166 +/- 20/95 +/- 16 to 149 +/- 22/87 +/- 16 mmHg and 151 +/- 14/89 +/- 12 to 143 +/- 15/84 +/- 11, both P < .0001). At 12 months, the blood pressure reduction was maintained and the number of antihypertensive drugs decreased from 4.9 +/- 1.2 to 4.4 +/- 1.5 (P = .0001). There were no significant procedure-related complications. The response rate to denervation at 1 year was 80%, but there were wide differences between centers. Conclusions: In patients with resistant hypertension, treatment with renal denervation was related to a decrease in office blood pressure and, more importantly, in ambulatory blood pressure monitoring, with a significant reduction in pharmacological treatment. (C) 2019 Published by Elsevier Espana, S.L.U. on behalf of Sociedad Espanola de Cardiologia.

Introducción: La finalidad del estudio es desarrollar un sistema claro y objetivo de priorización de listas de espera específico para cirugía de varices, con el que se pudiera mejorar su acceso a los servicios de salud. Material y métodos: Diseño de un sistema de priorización de lista de espera mediante la aplicación de la metodología del “Análisis de conjuntos”. En la primera etapa se seleccionaron los criterios y niveles a tener en cuenta para la priorización” mediante la organización de dos reuniones estructuradas con “grupos focales”, una con pacientes y otra con profesionales médicos. En una segunda fase se definieron todas las combinaciones posibles de dichos criterios y niveles definiendo así a todos los pacientes posibles que han de ser priorizados, seleccionando una muestra de todos ellos mediante el “sistema factorial fraccional ortogonal”. En una tercera fase se solicitó a diversos colectivos implicados en la lista de espera de varices la ordenación, según sus preferencias, de los escenarios seleccionados en la anterior fase para así conocer, aplicando el “método paramétrico de regresión multivariante del logit ordenado”, las puntuaciones de utilidad de cada uno de los criterios y niveles. Ello se llevó a cabo en dos fases, siendo la primera o “prueba piloto” la que se desarrolló para comprobar la utilidad del cuestionario, aplicándose a transeúntes de la ciudad de Barcelona. La fase final se realizó mediante una entrevista estructurada que se aplicó de forma personal y mediante correo electrónico a cirujanos vasculares, médicos generales, personal de enfermería, pacientes y sus familiares Finalmente se estandarizó cada una de estas puntuaciones de utilidad definiendo un sistema lineal entre 0 y 100 puntos, siendo 0 puntos el nivel más bajo de prioridad y 100 puntos el de mayor prioridad. En una última fase se validó el cuestionario seleccionado evaluando diferentes características: validez aparente, validez predictiva, validez de constructo y consistencia interna o dominancia. Resultados: El grupo focal de profesionales fue formado por 8 miembros escogidos por diversas sociedades científicas y por profesionales asistenciales. El segundo grupo focal fue formado por ocho pacientes con varices. Las variables principales escogidas finamente para ser utilizadas fueron la “gravedad de la patología”, con tres niveles, “complicaciones”, definida según hayan presentado o no, “factores laborales agravantes”, definida por presentes o ausentes, “influencia en la calidad de vida”, dividida en tres niveles y “tamaño de las varices”, definida en dos niveles. En la fase final se realizaron las entrevistas estructuradas a 762 individuos: 290 pacientes, 99 familiares, 179 médicos de familia, 32 miembros del personal de enfermería y 162 cirujanos vasculares. El sistema final fue: gravedad de la patología (gravedad leve 0 puntos, moderada 26 puntos y severa 50 puntos); presencia de complicaciones (sin complicaciones 0 puntos y con complicaciones 18 puntos); influencia en la calidad de vida (afectación leve 0 puntos, moderada 8 puntos y severa 16 puntos); factores laborales agravantes (sin factores laborales 0 puntos y con factores 9 puntos); finalmente el tamaño de las varices (varices normales 0 puntos y grandes 7 puntos). El sistema final presenta una correcta validación, tanto aparente, como predictiva (correlación de Spearman r=0,98, p, Introduction: Waiting lists for varicose vein surgery are the consequence of an imbalance between supply and demand for treatment. The aim of this study was to develop a clear, objective system to prioritize patients on the surgical waiting list according to the severity of their condition. Material and methods: The conjoint analysis technique was used to develop an approach to prioritize patients on waiting lists for varicose vein surgery. In the first stage, we organized two focus groups of healthcare professionals, patients and relatives to select the main outcome measures to take into account for the triage score. All the possible combinations of these criteria were then defined. Using the orthogonal fractional factorial design, we selected sample scenarios used in a structured survey. We applied the survey in two phases to several groups involved in the management of the varicose vein waiting list. We conducted a pilot phase to randomly-selected citizens in Barcelona to determine the usefulness of the questionnaire. We then administered the questionnaire via email and via a structured face-to-face interview with vascular surgeons, general practitioners, nurses, patients and their families. We used multivariate ordered logit regression to determine the utility scores for each item. Based on these findings, we defined a linear system of between 0 and 100 points, where 0 denotes lowest priority and 100 denotes highest priority. The last step in the study was the validation of the questionnaire. We evaluated its apparent validity, predictive validity, construct validity, and internal consistency or dominance. Results: The professional focus group consisted of 8 members nominated by scientific vascular societies and healthcare professionals. A second focus group was composed of eight patients with varicose veins. The main final outcomes were: disease severity (mild, moderate, severe), complications (absent or present ), work-related aggravation (absent or present), influence on quality of life ( mild, moderate, severe), and size of varicose veins (medium-sized, large). In the final phase, structured interviews were conducted with 762 individuals: 290 patients, 99 families, 179 family doctors, 32 staff nurses, and 162 vascular surgeons. After computing the relative weight of each variable, the priority scores were: disease severity (mild severity=0 points, moderate=26, severe=50), presence of complications (no complications=0 points, complications=18 points), influence on quality of life (mild=0 points, moderate=8, and severe= 16), work-related aggravation (absent=0 points, present= 9 points), and size of varicose veins (medium-size=0 points; large = 7 points). The system showed good apparent validity, predictive validity (Spearman correlation r = 0.98, p

Antecedents La incidència de la malaltia arterial perifèrica i la seva associació amb la malaltia coronaria han sigut estudiades prèviament. Aquests estudis però, s'han realitzat en poblacions amb elevada incidència de cardiopatía isquèmica. Objectius - Determinar la prevalença de la malaltia arterial perifèrica (MAP) al nostre àmbit. - Avaluar la associació de la MAP amb el desenvolupament de futurs events coronaris a 5 anys. - Determinar la incidència de MAP durant un seguiment de 5 anys i realitzar un model de predicció de risc de MAP. Subjectes i Mètodes Estudi poblacional prospectiu realitzat al districte urbà de Pubilla Casas, Hospitalet de Llobregat, Barcelona. La població d'estudi va comprendre els mascles d'entre 55 i 74 anys. Es varen recollir com a variables basals la existència de factors clàssics de risc, els antecedents de malaltia coronaria i cerebro-vascular, i es va realitzar l'índex turmell/braç (IT/B) a tots els subjectes. Per fer el diagnòstic de MAP es va requerir la confirmació d'un IT/B 70 years-old, 21.5% for smokers >40paq·año, 29.4% y 25% for subjects with previous cerebro-vascular and coronary events respectively, being 6% if these risk factors were absent. Conclusions In our cohort, subjects with PAOD have 3-fold higher risk of coronary event in next 5 years. This association and their magnitude is similar to that published previously for populations with higher coronary heart disease incidence. This fact confirms the importance of ankle-braquial index like a predictor factor for cardiovascular morbidity and mortality. In the studied population, 11.9% of safety subjects between 55 to 74 years old developed PAOD during 5 years follow up. Subjects aged 70 or more years old, severe smokers, and these with previous cardiovascular events, were who have higher risk to develop PAOD. These higher risk groups should be the priority objective of preventive measures.