Background. Current endografts used in treatment of abdominal aortic aneurysm (AAA), use large (18-25F) delivery systems. Graft fixation and aneurysm sealing is obtained by a proximal stent, requiring an aortic neck >15 mm. Objective. To compare the efficacy and safety of Ovation™ endograft (TriVascular, USA) with standard endografts. Methods. Between November 2009 and August 2010 we treated 47 AAA. In 10 patients we used Ovation™ (Group 1). Ten patients treated during the same period with commercially available endografts were used as controls (Group (2). The Ovation™ endo-prosthesis is tri-modular, made of PTFE andnitinol with low profile (13-15F) and has a barbed suprarenal stent for fixation. Sealing is obtained independently through 2 inflatable rings filled with a biocompatible polymer during the procedure. Implantation followed the standard procedure through femoral exposure, using the Philips Allura imaging equipment (Best, Netherlands). Procedure duration, length of stay (LOS) and complications were compared between groups. Fisher exact test and unpaired Student’s t test were used for comparisons. Results. Results. Technical success was 100%. We observed no difference between groups (age, sex, AAA size, ASA risk, preoperative lab work). Procedure time (hrs) was 2,12 ± 0,7 vs. 2,0 ± 0,6 (NS), LOS (hrs) was 44,5 ± 10,7 vs. 49,5 ± 32,0 (NS) in Groups 1 and 2, respectively. Aneurysm neck length and ICU stay were shorter in Group 1 (p= 0,035 and 0,0451 respectively). During a 12 month follow up no adverse events, type I or III endoleak, or secondary interventions have occurred. Conclusion. Results with Ovation™ are comparable to other endografts currently available, achieving the same standards of efficacy and safety. Its highly flexible delivery system allows navigation through small vessels, easy deployment and effective sealing of AAA with necks > 7 mm, broadening the span of patients suitable for endovascular treatment.

Introducción: Las endoprótesis actuales para tratar aneurismas aórticos (AAA) requieren introductores de alto diámetro (18-25F) y se sustentan excluyendo el aneurisma, mediante la fuerza radial de stents metálicos. Objetivo: prótesis Ovation™ (TriVascular, EEUU) con aquellas disponibles en el mercado. Material y Método: Entre Noviembre 2009 y Agosto 2010 tratamos 47 AAA. En 10 pacientes usamos Ovation™ (Grupo 1). Grupo Control (2): diez pacientes tratados contemporáneamente con endoprótesis comerciales. Ovation™ es tri-modular, de PTFE y nitinol con un stent barbado para fijación supra-renal. Sella bajo las arterias renales mediante 2 anillos llenados con un polímero durante el implante. Usa introductor 13-15F. Usa-Philips-Allura (Best, Holanda). Comparamos: duración del procedimiento, hospitalización y complicaciones. Utilizamos test de Fisher exacto y t de student no pareado. Resultados: Éxito técnico 100%. Sin diferencia entre grupos (edad, sexo, tamaño AAA, riesgo ASA, laboratorio preoperatorio). Tiempo operatorio (hrs): 2,12 ± 0,7 vs. 2,0 ± 0,6 (NS). Estadía postoperatoria (hrs): 44,5 ± 10,7 vs 49,5 ± 32,0 (NS). El cuello del AAA y la permanencia en UTI fueron más cortos en grupo 1 (p= 0,035 y 0,0451). Seguimiento (4,5-12 meses) sin eventos adversos, endofugas tipo I ni III, ni re-intervenciones. Conclusiones: Los resultados con Ovation™ a corto plazo son comparables con los de otras endoprótesis, cumpliendo con estándares de eficacia y seguridad. Ovation ™ navega por vasos pequeños, permite un despliegue preciso y sellado efectivo en cuellos > 7 mm, ampliando el tratamiento endovascular del AAA.

Open and endovascular surgery are therapeutic alternatives for the treatment of abdominal aortic aneurism. The development of guidelines for its treatment requires a thorough analysis of available evidence to recommend the best treatment for each country's reality. Prospective randomized trials have shown best initial results with endovascular surgery, with higher hospital costs than open surgery. The requirement of anatomical suitability for the placement of endovascular prostheses limits the universal use of endovascular surgery. Moreover, this type of surgery needs a strict imaging and clinical follow up due to the high rates of late complications, which range from 20% to 40%. Many of these complications require further surgical interventions, elevating costs of treatment. The initial benefit of endovascular surgery is lost during long follow up as survival curves become similar to those of open surgery. Even for patients with a high surgical risk, the benefits of endovascular surgery are doubtful.

Background: Inferior vena cava (IVC) filters are used to prevent massive pulmonary embolism in cases where anticoagulation is contraindicated or has failed. It is usually implanted below the renal veins. In a few cases it is necessary to deploy the filter above them, with theoretical rísk of secondary renal failure. Aim: To report the experience with filters located above the renal veins. Patients and Methods: Medical records of all patients with percutaneous suprarenal filters are reviewed. Results: Between May 1993 and May 2007, 361 percutaneous IVC filter procedures were performed. In thirty patients aged 19 to 77 years (average 48years, 50% males), they were placed in suprarenalposition (8,3%). Suprarenal IVC filters were implanted in patients with extensive caval thrombosis, renal vein thrombosis extending to cava, displacement of previous IVC filters and double IVC system. Jugular vein approach was the access of choice. Technical success was 100%, no death or pulmonary embolism occurred. Patients were followed from 1 to 165 months (average 57 months). Eight deaths were recorded, five in patients with cáncer No patient had renal failure on follow up (average creatinine 0.90+0,26 mg/dL). Three patients developed a new deep vein thrombosis (10%), without pulmonary embolism. Conclusions: In this retrospective analysis of patients, suprarenal placement of IVC filters was not associated to secondary renal failure, and showed good short and long term results.

Background: Endovascular repair of abdominal aortic aneurysms (AAA) avoids laparotomy, shortens hospital stay and reduces morbidity and mortality related to surgical repair, allowing full patient recovery in less time. Aim: To report short and long term results of endovascular repair of AAA in 80 consecutive patients treated at our institution. Patients and Methods: Between September 1997 and February 2005, three women and 77 men with a mean age 73.6±7.7 years with AAA 5.8±1.0 cm in diameter, were treated. The surgical risk of 38% of patients was grade III according to the American Society of Anesthesiologists classification. Each procedure was performed in the operating room, under local or regional anesthesia, with the aid of digital substraction angiography. The endograft was deployed through the femoral artery (83.7% bifurcated, 16.3% tubular graft). A femoro-femoral bypass was required in 11.3% of cases. Follow-up included a spiral CT scan at 1, 6 and 12 months postoperatively, and then annually. Results: Endovascular repair was successfully completed in 79/80 patients (98.7% technical success). The procedures lasted 147±71 min. Length of stay in the observation unit was 20.6±13.5 h. Blood transfusion was required in 10%. Sixty two percent of the patients were discharged before 72 h. One patient died 8 days after surgery due to a myocardial infarction (1.3%). During follow-up (3-90 months), 1 patient developed late AAA enlargement due to a type I endoleak, requiring a new endograft. No AAA rupture was observed. Survival at 4 years was 84.2% (SE =9.2). Endovascular re-intervention free survival was 82.7% (SE =9.5). Conclusion: Endovascular surgery allows effective exclusion of AAA avoiding progressive enlargement and/or rupture and is a good alternative to open repair. Close and frequent postoperative follow up is mandatory

OBJETIVO: A cirurgia endovascular se estabeleceu como opção eficaz no tratamento da doença oclusiva aterosclerótica das artérias ilíacas. Entretanto, o uso desses procedimentos para tratar outros tipos de lesão ainda não foi bem estudado. Nosso objetivo é analisar indicações e resultados do uso de endoprótese em lesões ilíacas não-oclusivas. MATERIAL E MÉTODOS: Revisamos retrospectivamente os registros de 14 pacientes consecutivos, todos homens, com idade média de 61,6 anos (faixa: 25-80 anos), tratados por via endovascular entre 2001 e 2006 por lesões ilíacas não-oclusivas. O estudo pré e pós-operatório incluiu tomografia computadorizada. O procedimento foi realizado em bloco cirúrgico, utilizando um angiógrafo digital. Foi utilizado acesso femoral, com a inserção de endopróteses tubulares. RESULTADOS: Em 11 pacientes, houve embolização de artéria hipogástrica ipsilateral associada. As patologias tratadas foram: oito aneurismas ateroscleróticos, 3 dissecções, 2 lesões traumáticas e um pseudo-aneurisma anastomótico. A comorbidade mais freqüente foi hipertensão, em 43% dos casos. Não houve mortalidade operatória. Um paciente apresentou um pseudo-aneurisma femoral tratado com compressão. Um paciente tratado por fístula arteriovenosa traumática em nível ilíaco teve sua insuficiência cardíaca resolvida, com persistência assintomática de mínimo fluxo. A estada pós-operatória foi de 3 dias (média). Não se apresentaram outras endofugas inciais ou tardias. Durante um acompanhamento médio de 20,5 meses (faixa de 1 a 49 meses), um paciente morreu de câncer e nenhum requereu procedimentos complementares. CONCLUSÃO: O tratamento endovascular de lesões ilíacas através de endoprótese é seguro e permite um resultado durável no manejo de um amplo espectro de patologias.

OBJETIVO: La cirugía endovascular se ha establecido como una opción eficaz en el tratamiento de la enfermedad oclusiva ateroesclerótica de las arterias iliacas. Sin embargo, el uso de estos procedimientos para tratar otro tipo de lesiones aún no ha sido bien estudiado. Nuestro objetivo es analizar indicaciones y resultados del uso de endoprótesis en lesiones iliacas no oclusivas. MATERIAL Y MÉTODOS: Revisamos retrospectivamente los registros de 14 pacientes consecutivos, todos hombres, 61,6 años de edad en promedio (rango: 25-80) tratados por vía endovascular entre 2001 y 2006 por lesiones iliacas no oclusivas. El estudio pre y postoperatorio incluyó tomografía computada. El procedimiento se efectuó en quirófano, utilizando un angiógrafo digital. Se usó acceso femoral insertando endoprótesis tubulares. RESULTADOS: En 11 pacientes se asoció embolización de arteria hipogástrica ipsilateral. Las patologías tratadas fueron: ocho aneurismas ateroescleróticos, 3 disecciones, 2 lesiones traumáticas y un pseudoaneurisma anastomótico. La co-morbilidad más frecuente fue la hipertensión en 43% de los casos. No hubo mortalidad operatoria. Un paciente presentó un pseudoaneurisma femoral tratado con compresión. Un paciente tratado por fístula arteriovenosa traumática a nivel iliaco resuelve su insuficiencia cardiaca, con persistencia asintomática de mínimo flujo. La estadía postoperatoria fue de 3 días (mediana). No se presentaron otras endofugas iniciales o tardías. Durante un seguimiento promedio de 20,5 meses (rango 1 a 49), un paciente fallece por cáncer y ninguno ha requerido procedimientos complementarios. CONCLUSIÓN: El tratamiento endovascular de lesiones iliacas mediante endoprótesis es seguro y permite un resultado durable en el manejo de un amplio espectro de patologías.

Background: The incidence of abdominal aortic aneurysms has increased. Its predisposing factors are smoking, high blood pressure and dislipidemia. Progressive aneurysmal enlargement may lead to its rupture, which is associated to a mortality rate above 80%. Aim: To assess the prevalence of abdominal aortic aneurysms in Chilean subjects with cardiovascular risk factors. Subjects and methods: Through announcements in open media we invited individuals aged over 60 years, who smoked, had hypertension and/or had occlusive arterial disease, to participate in a study that included medical history and physical examination. An aortic ultrasound was performed in all subjects in whom the aorta was not palpable or there was a suspicion of dilatation. Aortic diameter over 3 cm was considered aneurysmal. Results: Three hundred fifty six subjects aged 67.1±6.7 years, (73.9% males), were evaluated. The study group included 62% hypertensives, 39% with abnormal lipids and 46% smokers. Known coronary heart disease or peripheral arterial diseases were present in 14% and 10%, respectively. Ultrasound was required in 159 subjects. Aneurysms were detected in 21 persons (5.9%), 7.6% in males and 1.1% in females. The mean transverse diameter of the aneurysm was 4.1 cm (3-7.5). Aneurysm was found in 2.3% of subjects younger than 65 years and 8.3% of subjects aged over 65 years. Conclusions: In this sample the prevalence of abdominal aortic aneurysms was 5.9%, affecting predominantly males, with a notorious increase with advanced age (Rev Méd Chile 2003; 131: 741-7)

The treatment of superior vena cava syndrome is usually oriented to the underlying cause, that can be too slow in emergency cases. We report a 49 years old woman with a multiple myeloma that was admitted due to a superior vena cava syndrome caused by a central venous catheter used for chemotherapy for 20 weeks. She was successfully treated with thrombolysis, angioplasty and stent placement. The patient died 7 months later due to the underlying disease. Long term catheters are the responsible for 20 to 30% of superior vena cava syndromes. Endovascular treatment of the syndrome is successful in 60 to 100% of cases with a symptomatic relapse in 4 to 45% of patients. (Rev Méd Chile 2001; 129: 421-6)