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Objective: The present study describes an ambulatory, free skin micrograft technique with cyanoacrylate as a coadjuvant venous leg ulcer (VLU) healing strategy and its outcomes after one month. Methods: This prospective study involved Comprehensive Classification System for Chronic Venous Disorders (CEAP) stage C6 patients with good granulation tissue and negative culture results, consecutively recruited in January 2017 in the Hospital Clinico San Carlos. A skin micrograft was harvested from the anterior surface of the patient's thigh with a 0.4cm punch (0.12cm2). The graft was adhered to the ulcer bed with cyanoacrylate. Anti-adherent dressing and double-layer bandaging was applied, with weekly replacements. Measurements were obtained of the surface of the VLU and graft progression (in cm2) using a photographic grid. Results: A total of 12 VLUs in 12 patients were included, with a mean treated surface of 20.32±13.9cm2. A total of 18 grafts were placed and all were found to be viable after one week. Average graft growth was not noticeable after one week but was found to be 0.25±0.08cm2 after week two, 0.41±0.98cm2 after week three, and 0.70±0.15cm2 after week four (pConclusion: The findings of this study show that free skin micrografting with cyanoacrylate as outpatient treatment for VLUs was simple, rapid and without complication in this study, and may contribute to its wider application in clinical use.

espanolLa trombosis venosa superfi cial (TVS) de miembros inferiores venia considerandose como una patologia de naturaleza benigna con un curso clinico autolimitado. Actualmente se conoce que sus potenciales complicaciones pueden ser graves o incluso mortales, como la trombosis venosa profunda o el tromboembolismo pulmonar. Existen diferentes formas de presentacion clinica, factores de riesgo y diferentes tratamientos para su abordaje, principalmente en Atencion Primaria. Nuestro grupo de trabajo de vasculopatias de la Sociedad Espanola de Medicos de Atencion Primaria (SEMERGEN) ha elaborado esta actualizacion con la evidencia cientifi ca actual de forma conjunta con el Capitulo Espanol de Flebologia y Linfologia de la Sociedad Espanola de Angiologia y Cirugia Vascular. EnglishThe superfi cial venous thrombosis of the lower limbs was considered a pathology of a benign nature with a self-limiting clinical course. It is now known that its potential complications can be serious or even deadly, such as deep vein thrombosis or pulmonary thromboembolism. There are diff erent forms of clinical presentation, risk factors and diff erent treatments for its approach mainly in Primary Care. Our working group of vasculopathies of the Spanish Society of Primary Care Physicians (SEMERGEN) has developed this update with the current scientifi c evidence jointly with the Spanish Chapter of Phlebology and Lymphology of the Spanish Society of Angiology and Vascular Surgery

Carlos Lahoza,∗, Carlos Esteban Graciab, Leonardo Reinares Garciac, Sergi Bellmunt Montoyad, Angel Brea Hernandoe, Alvaro Fernandez Herederof, Manuel Suarez Tembrag, Marta Botas Velascoh, Carlos Guijarro i, Esther Bravo Ruiz j, Xavier Pintok, Melina Vega de Ceniga l y Guillermo Monux Ducajum, en representacion del grupo de prevencion secundaria de la Sociedad Espanola de Arteriosclerosis y de la seccion de medicina vascular de la Sociedad Espanola de Angiologia y Cirugia Vascular

Objective Surgical treatment of popliteal artery aneurysms (PAAs) has advanced over time. Constant development of new endovascular techniques has converted these into the most attractive methods available today. However, results for each endovascular procedure are still limited, and available data have emerged from studies examining only a small number of cases. The present retrospective review was designed to examine early and late results for PAA treatment and to identify possible factors associated with graft patency. Methods This was a retrospective review of all PAAs treated from January 1993 to December 2013. Symptomatic and asymptomatic PAAs >2 cm treated using open surgery or an endovascular procedure were included. Kaplan-Meier curves and the Breslow test were used to analyze data. Results A total of 171 aneurysms were treated in 142 men (mean age, 69.3 years); of these, 53.3% were asymptomatic and 18.7% presented as acute ischemia. Saphenous vein was used for bypass in 57.9% of the patients, expanded polytetrafluoroethylene (ePTFE) in 23.4%, and a stent graft in 18.7%. In the open surgical group, a popliteal-popliteal bypass was performed in 37.4% and a distal anastomosis to a tibial vessel was required in 14.4%. Good runoff (two to three vessels) was present in 69%. Perioperative mortality (30 days) was 1.8%. Of eight early occlusions recorded, five (2.9%) underwent reoperations. Major amputations were needed in five patients (all with previous acute ischemia). Median follow-up for the entire cohort was 49 months (range, 1-228 months). Primary and secondary patency rates at 24, 36, and 60 months were 76.3% and 89.5%, 73.4% and 87.4%, and 68.3% and 80.9%, respectively. Popliteal-popliteal bypasses showed better primary patency at 24 months when saphenous vein was used vs ePTFE (94.9% vs 79%; P = .04); however, similar patency rates were recorded for short ePTFE bypasses and stent grafts (79% vs 79.7%). On multivariate analysis, only poor runoff emerged as an independent factor for worse primary patency (hazard ratio, 3.5; 95% confidence interval, 1.7-7.2; P = .001). Conclusions The open repair of PAA offers good long-term results, especially in asymptomatic patients, those undergoing elective surgery, and those showing good runoff. Given the also good midterm outcomes of endovascular treatment, this may be a feasible option in selected patients.

Resumen Objetivo El objetivo del presente estudio es determinar si el empleo de dispositivos de autotransfusian es util en las reconstrucciones del sector aortoiliaco por patologia oclusiva. Material y metodos Se analizo de forma retrospectiva el empleo del autotransfusor en 227 procedimientos electivos primarios realizados sobre la aorta por patologia oclusiva del sector aortoiliaco. Se valoraron los factores de riesgo, valores hematologicos preoperatorios, volumen reinfundido por el autotransfusor y administracion de sangre homologa. Se realizo, ademas, una valoracion del coste economico derivado del uso de AT. Resultados De los 227 procedimientos, 201 fueron bypasses aortobifemorales y 26 aortofemorales. El uso del autotransfusor se asocio a una disminucion en la cantidad de unidades de sangre homologa administrada en los pacientes intervenidos de bypass aortobifemoral (1,7 frente a 3 unidades, p El coste del dispositivo de autotransfusian se justifico con recuperaciones superiores a 440 ml de sangre. Siguiendo este criterio, el autotransfusor resulto rentable desde un punto de vista de costes en el 36% de los pacientes (37% en los aortobifemorales y 20% en los aortofemorales). El uso de autotransfusor supone en nuestro medio un coste aproximado adicional de unas 3.000 ptas. por paciente en el caso de un bypass aortobifemoral y de 19.000 ptas. en un bypass aortofemoral. Conclusiones El empleo rutinario del autotransflisor esta justificado en el bypass aortobifemoral por patologia oclusiva. Reduce el consumo de sangre, con un discreto aumento de costes. En la cirugia unilateral, el empleo rutinario del autotransfusor no esta justificado, no reduce el consumo de sangre de banco y no es coste-efectivo.

Abdominal aortic aneurysm (AAA), defined as a permanent segmental dilatation of the abdominal aorta, is a pathology responsible for significant morbidity and mortality especially among adult population over 60 years of age. Indeed, AAA is one of the fifteen most frequent causes of death among men older than 55 years in Western societies (Lederle et al., 2000). However, despite of its importance, little is known about etiopathogenesis of AAA. The observation by non-invasive imaging methods of an abdominal aorta of 3 cm typically or large in maximal diameter is generally considered to indicate aneurysm formation (Lederle et al., 2000). Diagnosis is typically made by non-invasive imaging modalities such as ultrasound, computerized tomography scan or magnetic resonance imaging with formal aortic angiography utilized in special clinical scenarios. At present, surgical treatment, conventional or endovascular surgery of AAA are very effective to prevent AAA rupture in patients with large AAA, at least 5,5 cm in diameter, with high risk of rupture. However, despite AAA with diameter