Cirugia Cardiovascular最新文献

Surgical revascularization techniques of the lower extremities cover a wide spectrum of procedures. This review attempts to address peripheral arterial disease with intermittent claudication and chronic limb-threatening ischemia separately, providing clear and precise guidelines based on current scientific evidence.

Chronic kidney disease is a relatively frequent and evolutionary pathology, which in its final stage leads to renal replacement therapy. The most widely used is hemodialysis and to carry it out the patient must have adequate vascular access that allows a sufficient blood flow to be related to the hemodialysis machine. We usually talk about 2 great options to achieve vascular access, the arteriovenous fístula (AVF) and the central venous catheter (CVC).

At present, it is known that the type of VA, both at the beginning and in the follow-up of hemodialysis, has a direct relationship with the mortality and morbidity of the patient.

All of this justifies the creation of multidisciplinary working groups to comprehensively address the management of VA in hemodialysis patients whose ultimate goal should be to achieve the highest possible incidence and prevalence of native vascular access.

Efficient coordination of these multidisciplinary groups has shown a decrease in the prevalence of catheters, highlighting the importance of a coordinating figure/s of these specialists.

There has been a major change in revascularisation options for occlusive aortoiliac disease with the advent of endovascular techniques. In this review we will examine the different treatment strategies in this sector, starting with open surgery (anatomical revascularisation techniques, such as extra-anatomical) and ending with endovascular treatment. In this last section, we will describe not only the technique but also review the necessary materials, the different types of stents, and relevant tips and tricks to perform this type of intervention successfully.

This is a review article on conventional distal and ultradistal revascularization in chronic limb-threatening ischemia. The operative plan to approach distal and femoropopliteal disease is described with the most relevant technical details. Moreover, the alternative surgical techniques employed in the most complex patients are also described with the most important postoperative outcomes.

Introduction

In patients with peripheral arterial disease, the femoropopliteal sector is a very commonly affected location, with a prevalent concomitance with infrapopliteal arterial disease, especially in patients with critical ischemia of the lower limbs.

Methods

Through an exhaustive bibliographic analysis that aims to present a holistic vision of endovascular techniques for lower limb revascularization in the infrainguinal segments, the materials, as well as the diagnostic and therapeutic strategies, are presented and described.

Results

Percutaneous endovascular treatment reduces morbidity and mortality and hospital stay. An adequate approach to peripheral arterial disease is important, personalizing the diagnostic and therapeutic management for each patient and type or degree of involvement. It is also crucial to distinguish the peculiarities of each arterial segment.

Conclusions

Both an adequate imaging diagnosis and multidisciplinary committees are necessary to optimize the selection process of patients who are candidates for endovascular or surgical techniques or combined treatments.

The cardiovascular surgeon, in order to be able to perform with agility and confidence, must know the anatomy perfectly, in order to enter the human body safely, this being one of the basic pillars of our day to day. If we know the way to reach our destination everything becomes much clearer and easier, we have to learn «how to get there» and once there decide «what to do». For this reason this article tries to explain in a clear and practical way the approaches to the femoro-popliteal and distal sector, in order to facilitate the interventions at this level.