Background: Anticoagulation is the treatment of choice for deep vein thrombosis (DVT) and pulmonary embolism (PE). Occasionally this treatment is contraindicated or fails to prevent PE. In these patients, inferior vena caval (IVC) interruption is indicated and insertion of a filter is the most commonly performed procedure. Aim: To report the experience with IVC filters. Material and methods: Retrospective review of all medical records and operative protocols of patients subjected to IVC filter implantations. Follow up was performed by telephone contact with the patient, relatives or primary physicians, ambulatory consultation or by death certificates. Results: During the period 1993-2005 we implanted IVC filters on 287 patients, 55.4% male, average age: 62.1 yrs (17-99). Indications for the procedure were DVT or PE and contraindication of anticoagulation in 141 patients (49.1%), DVT or PE and complication of anticoagulation in 65 patients (22.6%), prophylaxis in 39 patients (13.6%), massive PE or poor respiratory function in 31 patients (10.8%), paradoxal emboli in 4 patients (1.4%) and other causes in seven patients. All percutaneous devices were successfully inserted. There was no morbidity or mortality related to the procedure. The most frequent access site was the internal jugular vein (66.6%). In 24 patients (8.4%) the filter was intentionally deployed above the renal veins. Six patients (2.1%) were lost to follow up after discharge. A mean follow up of 41.5 months was achieved. Ninety one patients died, with a 5 years survival of 64.7%. Symptomatic recurrent PE occurred in 6 patients (2.1%) and was the cause of death on 3 of them (1%), DVT has been detected in 22 patients (7.7%) during the follow up period. Conclusions: IVC filter implantation is a safe and effective short and long term measure to prevent PE and its consequences

Surgical treatment of thoracoabdominal aneurysms is a big technical challenge with a high rate of complications and mortality. It requires a large exposure and transient interruption of vital organ perfusion during its repair. Endovascular repair is a less invasive alternative available over the last decade. We report four male patients aged 44 to 76 years, with thoracic aortic aneurysms and involvement of visceral aorta, treated with a two stage procedure. During the first stage, a retrograde revascularization of the superior mesenteric and renal arteries from the infrarenal aorta was done, associated in two cases to a concomitant repair of an infrarenal aortic aneurysm. In the second stage, an endovascular graft was placed through the femoral artery, from the segment proximal to the aneurysm to the infrarenal aorta, above the origin of the visceral artery reconstructions, excluding the aneurysm from circulation. In one patient, both stages were concomitant and in three the second stage was delayed. One patient presented a postoperative bleeding that required reintervention without adverse consequences. No patient died, presented paraplegia or deterioration of renal function. After follow up of 6 to 20 months, there is no evidence of aneurysm growth or complications derived from the procedure

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

Background: Superior vena cava syndrome (SVCS) is caused by the obstruction of venous drainage from the upper portion of the body. Common clinical findings are headache and cervical, facial and upper limb edema. Occasionally, clouding of consciousness appears. Aim: to report our experience with endovascular treatment of SVCS. Material and methods: Retrospective review of all patients with SVCS subjected to endovascular treatment between 1999 and 2005. Results: Eight patients were treated, all of them with malignancies. Six had a benign obstruction due to the presence of a chemotherapy catheter located in the superior vena cava, one had obstruction secondary to radiation therapy and one a tumor compression of the superior vena cava. Two patients underwent thrombolytic therapy. Angioplasty and stenting was performed in all patients. The chemotherapy catheter was removed to all patients and installed again in one. One patient had a hemothorax secondary to a simultaneous needle lung biopsy under video thoracoscopy. No patient died in relation to the procedure. Congestive signs and symptoms subsided in all patients within 24 hours after the procedure. During follow up, only one patient had symptoms related to vena cava obstruction and three died due to their malignant tumor. Conclusions: Endovascular treatment of SVCS has a low rate of complications and provides immediate and mid-term symptom relief

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: Mortality of traumatic aortic lesions is over 80%. A group of those who survive, develop a chronic pseudo aneurism, usually asymptomatic, that is detected during imaging studies. Since conventional surgical treatment of traumatic aortic lesions has a great mortality, endovascular treatment has been used as an alternative treatment in the last decade. Aim: To report our experience with endovascular treatment of traumatic aortic lesions. Patients and methods: Report of seven patients aged 22 to 65 years, with traumatic aortic lesions. Under general anesthesia an endovascular prosthesis was inserted through the femoral artery. Results: No complications were observed in the postoperative period, and after a follow up ranging from 4 to 40 months, no endoleaks or other complications have been detected. Conclusions: Endovascular treatment of traumatic aortic lesions has good immediate and midterm results

Background: The natural history of aneurysms ends in rupture and death. In 1990 the first endovascular exclusion of an aneurysm, using an endoluminal graft implanted through the femoral arteries was performed. More recently, the same procedure has been used for aneurysms of the thoracic aorta. Aim: To report our experience with endovascular treatment of thoracic aorta aneurysms. Material and methods: Analysis of 14 patients (nine male), aged 30 to 79 years, treated between May 2001 and August 2002. Results: The mean diameter of the aneurysms was 6.9 cm. The etiology was atherosclerotic in nine patients. The Excluder device (Gore<FONT FACE=Symbol>â</FONT>) was preferentially used. There was no operative mortality or paraplegia. One patient had a transient leg monoparesis that reverted completely. No patient had type I endoleaks. Two patients had type II endoleaks on discharge, that sealed spontaneously. In a follow up, ranging from 2 to 17 months, one patient died of a bronchopneumonia and no aneurysm rupture has been detected. Conclusions: The short term results of endoluminal treatment of thoracic aorta aneurysms are excellent. This treatment is less invasive and has less complications than conventional surgery (Rev Méd Chile 2003; 131: 617-22)

Traumatic rupture of the aorta has a near 80% mortality. Most patients die on the site of the accident. Conventional surgical repair of these lesions has a high morbidity and mortality, generally associated to the severity of associated lesions. Over the last decade, endovascular treatment has become an effective therapeutic alternative. We report a 40 years old male, that suffered a traumatic rupture of the descending thoracic aorta in a car accident. A successful endovascular repair was performed, installing an endoprothesis on the site of the lesion, using a femoral artery approach. The patient had a good postoperative evolution and was discharged from the hospital once complete rehabilitation of his associated lesions was obtained (Rev Méd Chile 2003; 131: 309-13).

The traditional treatment of traumatic lesions of the aortic arch branches requires extended surgical exposures, not exempt of morbidity and mortality. Over the last decade, devices that allow a minimally invasive treatment, have been developed. The vessel can be repaired without direct exposure, using an endovascular procedure. We report three patients with traumatic pseudoaneurysms of the left subclavian, brachiocephalic and left common carotid arteries, respectively. All lesions were successfully repaired with the insertion of an endograft. Although long term results of these procedure are unknown, repair of a future stenosis or occlusion is less complicated than the treatment required by the original lesion. Endoluminal repair appears as a safe, efficient and less invasive treatment for these lesions. (Rev Méd Chile 2002; 130: 1027-32)