Evolución y protetización de las amputaciones mayores en pacientes con enfermedad arterial periférica de nuestro centroOutcomes and prosthesis procedure of major amputations in patients with peripheral arterial disease in our center

Conflicto de intereses: los autores declaran no tener conflictos de intereses. RESUMENLos pseudoaneurismas de vena cava infrarrenal (VCI) son una patología infrecuente, sin tratamiento estandarizado; la mayoría, secundarios a traumatismos abdominales. Presentan una mortalidad del 20-57 %, que no se ha reducido a pesar de avances en el tratamiento.Las lesiones iatrogénicas de la VCI pueden desarrollar hematomas retroperitoneales y pseudoaneurismas. Su manejo debe ser individualizado, con opciones como conservador, quirúrgico o endovascular.

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Objective.To analyze and evaluate medium-term results obtained in endovascular treatment of complicated type B dissection.Methods.Prospective registry and retrospective analysis of the dissections treated with endoprosthesis in 1998 and 2010. Comorbidity, clinical presentation, anatomical characteristics, and evolution were recorded. Actuarial analysis was conducted for survival, follow-up and survival free of endoleaks, and free of reintervention due to relapse and/or progression.Results.Eighteen (18) patients were treated (14 male : 4 female), with a median age of 53 years (range 29–80). Their main symptoms were acute pain in 16 cases and hypertensive crisis in 15. The indications were 10 dissections not controlled by medication, 4 aneurysm dissecans, 2 acute lower limb ischemias, and 2 Type A progressions. Median 1.7 devices were used (range 1–4). Coverage of left subclavian artery was required in 3 cases, and of subclavian and left carotid artery in other 2 cases. There was a 100% technical success. Median follow-up was 43.1 months (1.5–127 range). There were two deaths caused by multiorganic failure, early mortality of 0%, and hospital mortality of 11%. There was a case of Type I Endoleak and 5 cases which required a new intervention due to relapse and/or progression. Cumulative survival at 30 months was 88%; follow-up free of endoleaks at 36 months was 91%. Follow-up free of progression/relapse at 12 months was 88%.Conclusion.Endovascular treatment of complicated type B acute dissection is an effective therapy for this condition, with a low associated mortality and with acceptable survival.