There is no evidence on which to base the ideal technique for the treatment of aorto-enteric fistulas (AEFs). A 54-year-old man presented with an AEF. He had previously undergone aortobifemoral bypass with an end-to-side proximal anastomosis. An Endurant II aorto-uni-iliac endograft and a Complete SE stent soaked in rifampicin were implanted. After 12 hours, a second staged intervention was performed. The original graft was removed and the communication with the duodenum was repaired. A staged combination of endovascular repair for acute bleeding control and open surgical treatment, combined with systemic and local antibiotics might be considered the option of choice.

Los aneurismas inflamatorios de la aorta abdominal constituyen una entidad diferenciada de etiologia desconocida que se caracteriza por una gruesa pared, superficie nacarada y la presencia de tejido fibrotico perianeurismatico que atrapa las estructuras vecinas, especialmente los ureteres. Caracteristicamente, aparecen en varones, muy fumadores y con edad media de 65 anos y son mucho mas sintomaticos que los aneurismas no inflamatorios, siendo lo mas frecuente la aparicion de dolor abdominal, perdida de peso y elevacion de la VSG. La prueba de referencia para su diagnostico es el TAC, con una imagen tipica en cuatro capas (luz aortica, trombo mural, pared engrosada y masa periaortica retroperitoneal). Su tratamiento se basa en tres pilares: exclusion del aneurisma (cirugia abierta o endovascular), actuacion frente la fibrosis (corticoides e inmunosupresores) y manejo de las complicaciones por afectacion de organos adyacentes. La cirugia abierta presenta grandes dificultades tecnicas con una alta morbimortalidad, en cambio, el tratamiento endovascular constituye una opcion no solo posible, sino efectiva y segura, con unos resultados similares al tratamiento de los aneurismas no inflamatorios. El pronostico de estos pacientes depende de la evolucion de la fibrosis retroperitoneal, la cual es muy variable tanto en la cirugia abierta como endovascular. Las series de que disponemos son aun pequenas y de cortos periodos de seguimiento, por lo que es necesario hacer un seguimiento a largo plazo de la evolucion de la fibrosis post EVAR para llegar a conclusiones mas definitivas.

The objective of the work is to study the clinical and haemodynamic evolution, over 1 year, in patients with femoropopliteal arterial pathology treated by means of atherectomy with the SilverHawk device.Materials and methods: Nineteen (19) patients were treated between December 2008 and May 2009, collecting data on sex, age, comorbidity and clinical degree, with prospective monitoring over 12 months of clinical symptoms, physical examination and ecodoppler, obtaining results on diameter and peak systolic velocity at different arterial levels.Results: Of the 19 patients, 14 were men and 5 women, with a mean age of 70 years, hypertensive (73%), diabetic (63%) and smokers (63%). Six (6) presented disabling claudication and 13 critical ischemia with advanced distal trophic lesions in 5. A good arteriographic result was obtained in 12 cases, a stent was placed on the superficial femoral artery in 5 due to suboptimal outcome. Contrast extravasation was observed in 2, with femoropopliteal bypass performed and one exclusion with endoprosthesis for repair. In the ecodoppler after 1, 3, 6 and 12 months, a progressive reduction in lumen diameter and peak intraarterial systolic velocity was observed, particularly on the distal superficial femoral artery. After one year, 7 patients (36.8%) were symptom-free, 5 (26.3%) presented mild or moderate intermittent claudication and 1 patient (5.3%) presented localised distal trophic lesion. Four (4) major amputations were performed, in 2 the knee was preserved, there were 3 thromboses due to the procedure, a secondary endovascular procedure was performed in one case and a femoropopliteal bypass in another, and there were 2 non procedure-related deaths.Discussion: atherectomy with SilverHawk achieves an improvement in clinical degree, with a good rate of extremity salvage in patients with critical ischemia. In the first year, the ecodoppler shows evolution of the arteriopathy, without this necessarily meaning a clinical worsening. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

INTRODUCTION:Synchronous embolism to the superior mesenteric artery (SMA) and coeliac axis (CA) is a rare disease.REPORT:A 67-year-old man with atrial fibrillation developed acute liver failure due to an embolic occlusion of the CA and SMA, with a severe coagulation disorder. He was successfully managed with percutaneous stent placement and an exploratory laparotomy was not needed. He remains symptom-free 1 year after the procedure, and duplex follow-up showed stent patency.CONCLUSION:Endovascular techniques in patients with liver failure, no signs of peritonism, early diagnosis and high operative risk seem feasible and should be used if possible, as first-line option.

El cuidado minucioso del pie diabetico es vital para prevenir infecciones y complicaciones como amputaciones y sepsis. Ese cuidado debe empezar en la identificacion y un correcto diagnostico precoz, prevencion y tratamiento de las ulceras diabeticas. Revisamos la epidemiologia, caracteristicas clinicas, diagnostico, tratamiento y prevencion de las ulceras diabeticas, fundamentalmente en sus fases iniciales no complicadas.

espanolINTRODUCCION. Los traumatismos de aorta toracica aunque son infrecuentes (5% de los traumatismos vasculares) conllevan una alta mortalidad. En los ultimos anos han aparecido gran numero de articulos en la bibliografia analizando las distintas opciones terapeuticas de esta patologia. MATERIAL Y METODOS. Se realizo una busqueda bibliografica de la Nacional Library of Medicine (PubMed). Las palabras clave introducidas para realizar dicha busqueda fueron: lesiones traumaticas aorta toracica, tratamiento abierto, tratamiento endovascular. Se incluyeron los trabajos publicados desde Enero de 2006 hasta Diciembre 2009, en ingles y espanol. RESULTADOS. Con los limites citados anteriormente se encontraron 102 articulos y 25 revisiones, de los cuales eran referentes al tema 15 de ellos. CONCLUSIONES. El tratamiento endovascular de las lesiones traumaticas de la aorta toracica se asocia a bajas tasas de mortalidad y de paraplejia respecto a la cirugia abierta convencional EnglishINTRODUCTION. Injuries of the thoracic aorta are rare (5% of vascular injuries) carry a high mortality. In recent years, a large number of articles in the literature analyzing the different treatment options of this condition. MATERIAL AND METHODS. A bibliographical search has been done in the National Library of Medicine (PubMed). The key words introduced to realize the above mentioned search were traumatic injuries thoracic aorta, open repair, endovascular The included articles published from January 2006 until December of 2009, in English and Spanish. RESULTS. With the limits mentioned previously, we found 102 articles and 25 reviews, 15 of them were relating to the topic. CONCLUSION. Endovascular treatment of traumatic injuries of the thoracic aorta is associated with low rates of mortality and paraplegia respect to conventional open surgery.

espanolSe presenta por los autores un caso de tumor carotideo desarrollado en una joven. Se realiza una revision sobre el manejo de este tipo de patologia y se discute las caracteristicas del caso con la informacion disponible en la bibliografia. EnglishThe authors present a case of Carotid body tumor in a young women. A review of carotid body tumour management is made and have the discussion with the characteristics of the case in comparition of the information of the bibliography.

A systematic review of the medical literature was performed for relevant studies. We searched a number of electronic databases and hand-searched relevant journals since January 2002 until November 2007. We considered studies in which diagnosis and treatment were evaluated to diminish the morbimortality. Isquemia acute of the extremity is defined as any abrupt diminution of the perfusion that causes a possible threat to the viability of the same one. Isquemia acute of continuous inferior extremity associated to a high morbidity and mortality in spite of the advances in the perioperatorios cares and the techniques of revascularizacion. In special the age patients outpost they are exposed to a high risk of local serious complications as as much sistemicas. The comorbidity, the metabolic upheavals associated to isquemia acute and the syndrome of reperfusion are associate to this poor prognosis. In this article we set out an update in the handling of this type of patients presenting/ displaying new features in diagnosis and treatment. For it we have made a revision of Literature published in the last 5 years having centered in the works that contribute to new tools in diagnosis and treatment to us to reduce the high morbidity and mortality who present/display this type of patients

espanolA pesar de los recientes avances que han mejorado los resultados de la mayoria de las patologias quirurgicas en las ultimas decadas, la isquemia mesenterica continua constituyendo una enfermedad con una elevada morbilidad. Una elevada sospecha clinica, asi como el conocimiento de las diferentes posibilidades diagnosticas son esenciales para el correcto tratamiento de estos pacientes. El tipo de tratamiento depende en gran medida de la presentacion clinica asi como del tiempo de evolucion puesto que representa el factor de mayor importancia para determinar la viabilidad intestinal. La angioplastia transluminal y el stent de las arteria viscerales son unas alternativas viables en el tratamiento de la isquemia mesenterica cronica. Revisamos la fisiopatologia, la presentacion clinica y el estado actual de las tecnicas diagnosticas y terapeuticas. EnglishAlthough recent advances have improved outcomes in most surgical diseases over the last several decades, mesenteric ischemia remains a highly morbid condition. High clinical suspicious and knowledge of the differential diagnostic possibilities in this clinical setting are essential for the correct management of this patients. The type of the treatment depends largely on the clinical presentation, with time being the most important factor determining viability before irreversible damage occurs to the bowel. Transluminal angioplasty and stenting of the visceral arteries is a viable alternative for treatment of chronic mesenteric ischemia. We review the pathophysiology, the clinical presentation and the current state of the art in diagnosis and treatment