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Introducción. El síndrome de Leriche fue definido en 1940 por René Leriche como una enfermedad oclusiva aorto-ilíaca. Su importancia radica en que ocupa el segundo lugar en incidencia dentro de las enfermedades oclusivas arteriales, después de la enfermedad de la arteria femoral superficial. Objetivo. Presentar el caso clínico de un paciente con Síndrome de Leriche cuyo diagnóstico trombótico fue confirmado por una angiotomografía computarizada con su respectiva reestructuración en 3D. Adicionalmente, se informa al lector sobre los datos propios de la patología a través de una breve revisión de la literatura. Caso clínico. Paciente masculino con síntomas clínicos agudos de enfermedad oclusiva aorto-ilíaca o síndrome de Leriche en una extremidad. Se realiza el respectivo procesamiento de imagen asistida por computador (reconstrucción tridimensional) que evidencia la patología a pesar de que la ecografía Doppler no determinó trombosis inicial. Discusión. En procesos oclusivos arteriales se emplean técnicas no invasivas como la ecografía y la angiotomografía. Sin embargo, esta última es la técnica por excelencia, sobre todo para procesos trombóticos, pues agiliza la anticoagulación, así como el abordaje terapéutico. Conclusiones. La angiotomografía es una técnica no invasiva con alta sensibilidad y especificidad para detectar estenosis aorto-ilíaca. Se ha convertido en una gran herramienta diagnostica por sus alcances imagenológicos, como la obtención de imágenes iso volumétricas, que permiten evaluar todo el trayecto arterial en los diferentes planos, por medio del uso de medios de contraste, superando en resultados a la ecografía. Cómo citar: Picón-Jaimes YA, Díaz-Jurado JJ, Orozco-Chinome JE, Ramírez-Rodríguez PA, Arciniegas-Torres NA, Hernández-Sarmiento MA, Villabona-Rosales SA. Angiotomografía en sospecha de enfermedad oclusiva aorto-ilíaca (o síndrome de Leriche). MedUNAB. 2020;23(2): 301-306. doi: 10.29375/01237047.3732. Introduction. Leriche syndrome was defined in 1940 by René Leriche as an aortoiliac occlusive disease. Its importance lies in it occupying second place in the incidence of occlusive arterial diseases, after superficial femoral artery disease. Objective. Present the clinical case of a patient with Leriche syndrome whose diagnosis of thrombosis was confirmed by a computed tomography angiography with its respective 3D reconstruction. Additionally, the reader is given information about the pathology through a brief summary of the literature. Clinical case. Male patient with acute clinical symptoms of aortoiliac occlusive disease or Leriche syndrome in one limb. The respective computer-assisted image processing (three-dimensional reconstruction) is carried out, which shows the pathology, despite the Doppler ultrasound not initially establishing thrombosis. Discussion. Non-invasive techniques are used in procedures for occlusive arteries, such as ultrasound and CT angiography. However, the latter is a technique par excellence, above all for thrombosis procedures, as well as the therapeutic approach. Conclusions. CT angiography is a non-invasive technique with high sensitivity and specificity in the detection of aortoiliac stenosis. It has become a great diagnostic tool because of its imagery scope, such as obtaining isovolumic images, which enable the assessment of the entire arterial route in different planes, through the use of contrast media, producing more results than the ultrasound. Cómo citar: Picón-Jaimes YA, Díaz-Jurado JJ, Orozco-Chinome JE, Ramírez-Rodríguez PA, Arciniegas-Torres NA, Hernández-Sarmiento MA, Villabona-Rosales SA. Angiotomografía en sospecha de enfermedad oclusiva aorto-ilíaca (o síndrome de Leriche). MedUNAB. 2020;23(2): 301-306. doi: 10.29375/01237047.3732. Introdução. A síndrome de Leriche foi definida em 1940 por René Leriche como uma doença oclusiva aorto-ilíaca. Sua importância reside no fato de ocupar o segundo lugar em incidência dentro das doenças arteriais obstrutivas, após a doença na artéria femoral superficial. Objetivo. Apresentar o caso clínico de um paciente com síndrome de Leriche cujo diagnóstico trombótico foi confirmado por uma angiotomografia computadorizada (angio-TC) com reestruturação em 3D. Adicionalmente, o leitor é informado sobre os dados próprios da patologia através de uma breve revisão de literatura. Caso clínico. Paciente de sexo masculino com sintomas clínicos agudos da doença oclusiva aorto-ilíaca ou síndrome de Leriche em uma extremidade. Foi realizado o processamento da imagem assistida por computador (reconstrução tridimensional), evidenciando a patologia, ainda que a ultrassonografia Doppler não determinou trombose inicial. Discussão. Em processos oclusivos arteriais são utilizadas técnicas não invasivas como a ultrassonografia e a angiotomografia. No entanto, a angiotomografia é a técnica padrão ouro, principalmente para processos trombóticos, pois acelera a anticoagulação e a abordagem terapêutica. Conclusão. A angiotomografia é uma técnica não invasiva com alta sensibilidade e especificidade para detectar estenose aorto-ilíaca. Tornou-se uma ótima ferramenta de diagnóstico por suas características imagenológicas, como a obtenção de imagens isovolumétricas que permitem avaliar todo o trajeto arterial nos diferentes planos, através do uso de meios de contraste, superando os resultados da ultrassonografia. Cómo citar: Picón-Jaimes YA, Díaz-Jurado JJ, Orozco-Chinome JE, Ramírez-Rodríguez PA, Arciniegas-Torres NA, Hernández-Sarmiento MA, Villabona-Rosales SA. Angiotomografía en sospecha de enfermedad oclusiva aorto-ilíaca (o síndrome de Leriche). MedUNAB. 2020;23(2): 301-306. doi: 10.29375/01237047.3732.

Resumen: Introducción: El manejo endovascular para patologías de la aorta ha aumentado como opción para pacientes de alto riesgo quirúrgico de cirugía convencional abierta. Los resultados a corto plazo para mortalidad, libertad de enfermedad y reintervención, evidencian resultados favorables respecto a la cirugía abierta, pero a mediano (1-12 meses) y largo plazo (>1 año) no existen resultados en nuestro medio. Métodos: Estudio de cohorte bidireccional, en el cual se realizó el segmento retrospectivo en pacientes sometidos a manejo endovascular con prótesis aórtica y el segmento prospectivo en el seguimiento de los pacientes. Resultados: Se identificaron 194 pacientes entre abril de 2002 y diciembre de 2015 sometidos a tratamiento endovascular, que cumplían con los criterios de inclusión. El seguimiento se completó en el 82,2%. 92 casos (56.8%) de aorta abdominal con un seguimiento de 4,9 años (RIC 2,5-8,9. La sobrevida calculada fue 92% al año, 86% 2 años y 66.4% a los 5 años. El periodo libre de enfermedad fue 88.7% al año, 86.4% 2 años y 78.5% a los 10 años y 13 pacientes requirieron reintervención. 67 casos de aorta torácica con un seguimiento de 5,3 años (RIC 2,9-10.2), la sobrevida calculada 94% al año, 90.7% 2 años y 75.2% a los 5 años. El periodo libre de enfermedad fue 88.7% al año, 86.4% 2 años y 78.5% a los 10 años y 9 pacientes requirieron reintervención. Conclusiones: Los resultados obtenidos son favorables e incentivan para continuar ofreciendo el abordaje endovascular ya que la supervivencia y la libertad de reoperación se encuentran de acuerdo con lo reportado en la literatura. Abstract: Introduction: The endovascular management for diseases of the aorta has increased as an option for patients of high risk for conventional open surgery. The short-term mortality, disease-free and reoperation results, show favourable outcomes compared to open surgery, but there are no results available in this country for the medium (1-12 months) and long-term (>1 year). Methods: A bi-directional cohort study, in which the retrospective segment was conducted on patients subjected to endovascular management with an aortic replacement, and the prospective segment on the follow-up of the patients. Results: A total of 194 patients, subjected to endovascular treatment and met the inclusion criteria, were identified between April 2002 and December 2015. The follow-up was completed in 82.2% of cases. There were 92 (56.8%) cases of abdominal aorta with a mean follow-up of 4.9 years (95% range; 2.5-8.9). The calculated survival was 92% at one year, 86% at 2 years, and 66.4% at 5 years. The period free of disease was 88.7% at one year, 86.4% at 2 years, and 78.5% at 10 years, with 13 patients requiring re-operation.There were 67 cases of thoracic aorta, with a mean follow-up of 5.3 years (95% range; 2.9-10.2). The calculated survival was 94% at one year, 90.7% at 2 years, and 75.2% at 5 years. The period free of disease was 88.7% at one year, 86.4% at 2 years, and 78.5% at 10 years, and 9 patients required re-operation. Conclusions: The results obtained are favourable and are encouraging to continue offering the endovascular approach since the re-operation survival is similar to that reported in the literature. Palabras clave: Aorta torácica, Aorta abdominal, Enfermedades de la aorta, Aneurisma de la aorta, Procedimientos endovasculares, Keywords: Thoracic aorta, Abdominal aorta, Aortic diseases, Aortic aneurysm, Endovascular procedures

Introduction: The endovascular management for diseases of the aorta has increased as an option for patients of high risk for conventional open surgery. The short-term mortality, disease-free and reoperation results, show favourable outcomes compared to open surgery, but there are no results available in this country for the medium (1-12 months) and long-term (>1 year). Methods: A bi-directional cohort study, in which the retrospective segment was conducted on patients subjected to endovascular management with an aortic replacement, and the prospective segment on the follow-up of the patients. Results: A total of 194 patients, subjected to endovascular treatment and met the inclusion criteria, were identified between April 2002 and December 2015. The follow-up was completed in 82.2% of cases. There were 92 (56.8%) cases of abdominal aorta with a mean follow-up of 4.9 years (95% range; 2.5-8.9). The calculated survival was 92% at one year, 86% at 2 years, and 66.4% at 5 years. The period free of disease was 88.7% at one year, 86.4% at 2 years, and 78.5% at 10 years, with 13 patients requiring re-operation. There were 67 cases of thoracic aorta, with a mean follow-up of 5.3 years (95% range; 2.9-10.2). The calculated survival was 94% at one year, 90.7% at 2 years, and 75.2% at 5 years. The period free of disease was 88.7% at one year, 86.4% at 2 years, and 78.5% at 10 years, and 9 patients required re-operation. Conclusions: The results obtained are favourable and are encouraging to continue offering the endovascular approach since the re-operation survival is similar to that reported in the literature. © 2018 Sociedad Colombiana de Cardiología y Cirugía Cardiovascular

Penetrating aortic ulcer (PAU) is an ulceration of an atherosclerotic plaque which disrupts the aortic internal elastic lamina and that can evolve to an intramural hematoma (IH), aortic dissection or aortic rupture. We report two cases with PAU. A 73 year-old woman with a history of hypertension, presented with acute chest pain of three days of evolution and a hypertensive emergency. An electrocardiogram showed ST-segment elevation and elevated cardiac enzymes. Computed tomography (CT) scans showed an acute ascending aortic mural hematoma secondary to PAU and hemopericardium. Replacement of ascending aorta was performed with a vascular prosthesis with extracorporeal circulation (ECC). PAU and IH were confirmed by histopathology. A 62-year old woman with a history of hypertension, diabetes and chronic obstructive pulmonary disease, consulted for abdominal pain of two days of evolution. A thoracic-abdominal CT scan visualized an uncomplicated PAU and an abdominal aortic aneurysm. Because of abdominal pain and signs of peritoneal irritation, an exploratory laparotomy was performed finding a typhlitis. Resection and ileo-ascendo-anastomosis were performed. A new CT scan showed PAU with high risk of rupture without a clinical acute aortic syndrome. The patient was operated replacing the ascending aorta with a vascular prosthesis using ECC. Three PAU were found. Histopathology confirmed the diagnosis. Both patients evolved without postoperative complications.

Penetrating aortic ulcer (PAU) is an ulceration of an atherosclerotic plaque which disrupts the aortic internal elastic lamina and that can evolve to an intramural hematoma (IH), aortic dissection or aortic rupture. We report two cases with PAU. A 73-years-old-woman with a history of hypertension, presented with acute chest pain of three days of evolution and a hypertensive emergency. An electrocardiogram showed ST-segment elevation and elevated cardiac enzymes. Computed tomography (CT) scans showed and acute ascending aortic mural hematoma secondary to PAU and hemopericardium. Replacement of ascending aorta was performed with a vascular prosthesis with extracorporeal circulation (ECC). PAU and IH were confirmed by histopathology. A 62-years-old woman with a history of hypertension, diabetes and chronic obstructive pulmonary disease, consulted for abdominal pain of two days of evolution. A thoracic-abdominal CT scan visualized an uncomplicated PAU and an abdominal aortic aneurysm. Because of abdominal pain and signs of peritoneal irritation, an exploratory laparotomy was performed finding a typhlitis. Resection and ileo-ascendo-anastomosis were performed. A new CT scan showed PAU with high risk of rupture without a clinical acute aortic syndrome. The patient was operated replacing the ascending aorta with a vascular prosthesis using ECC. Three PAU were found. Histopathology confirmed the diagnosis. Both patients evolved without postoperative complications.

La enfermedad oclusiva aortoilíaca, o síndrome de Leriche, es una forma de la enfermedad arterial periférica, en la cual existe una oclusión de las arterias ilíacas desde su bifurcación. Su manifestación clínica es variable y la claudicación intermitente es la más frecuente; no obstante, es una enfermedad usualmente subdiagnosticada por su cronicidad y el sedentarismo de los adultos mayores, quienes más la presentan. Para el diagnóstico se cuenta con un abanico de opciones, que incluyen pruebas invasivas y no invasivas; la arteriografía es el método de elección. El tratamiento, por su parte, involucra cambios en el estilo de vida aunados a un tratamiento conservador o quirúrgico, según cada individuo. Aortoiliac occlusive disease (AIOD) or Leriche's syndrome is a form of peripheral arterial disease in which there is occlusion of the iliac arteries starting at the aorto- iliac bifurcation. Clinical manifestation are variable, with intermittent claudication being the most frequent; nevertheless, it is usually underdiagnosed because of its chronicity and the sedentarism of the elderly, the age group that is most frequently affected. A variety of options are available for the diagnosis, including invasive and non-invasive tests, arteriography being the method of choice. Treatment involves changes in the lifestyle coupled with a conservative or surgical management depending on the individual patient.

Normal 0 21 false false false /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tabla normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} Introduccion: La diseccion aortica tipo A es una patologia prevalente y de alta letalidad sin cirugia, estimandose en USA una incidencia de 6,6 casos por millon de habitantes. Pacientes y metodo : Entre Enero del 2000 y Agosto del 2008 operamos 100 pacientes en forma consecutiva (89 INT y 11 DIPRECA), 73 Hombres y 27 Mujeres. Edad promedio 55,43 anos (rango: 17-78 anos). 85 casos fueron agudos y 15 cronicos. En la comorbilidad preoperatoria destacaba 20 pacientes (22,47%) con shock cardiogenico o tamponamiento y 7 pacientes (7,87%) con insuficiencia renal aguda. La informacion se obtuvo del analisis de Fichas Clinicas. Se utilizo analisis univariado de Factores asociados a Morbi-mortalidad segun Test de Mann Whitney , considerando diferencias estadisticamente significativas si P ? 0,05. Resultados: La mortalidad operatoria global fue 26%; 27% en casos agudos y 20% en cronicos (P = NS), 50% en ? 70 anos y 21,43% en La complicacion mas frecuente fue sangramiento con necesidad de reexploracion en 18%. La sobrevida actuarial fue 70,1% a 5 anos. Solo 2 de 9 pacientes fallecidos en forma alejada, fueron de causas cardiovasculares. Conclusiones : Nuestros resultados muestran una baja morbi-mortalidad operatoria, a pesar de la gravedad preoperatoria de los pacientes del estudio. La elevada mortalidad observada en pacientes ? 70 anos nos indica la necesidad de una seleccion quirurgica mas estricta para este grupo etario. La mortalidad alejada no es baja (12,16%), pero no relacionada con la diseccion en la mayoria de los pacientes (aprox. 90%).

Background: Tipe A aortic dissection involves the ascending aorta and has high mortality rates without surgical treatment. Aim: To report the results of surgical treatment of type A aortic dissection. Material and Methods: Retrospective review of medical records of 100 patients aged 17 to 78 years (73% males) operated between January 2000 and August 2008, for type A aortic dissection. Follow up was performed with telephone interviews and review of national death records. Results: Eighty three percent of patients had an acute dissection. Operative mortality was 27 and 20% for patients with acute and chronic dissection, respectively. Mortality was 50% among patients aged 70 years or more, compared with 21% among their younger counterparts, The most common complication was bleeding that required a new surgical procedure in 18% of patients. Actuarial survival was 70% at five years. Cardiovascular problems caused the death of two of the nine patients that died during follow up. Conclusions: Surgical mortality among patients with type A aortic dissection was higher among patients with acute episodes and those aged 70 years or more

Background: Type B aortic dissection is usually managed by intensive care medical therapy and surgery is reserved for treating the complications that can occur during the evolution of a case. Aim: To assess the endovascular management of acute complications of type B aortic dissection and the closure of the intimal defect and aortic false lumen. Material and Methods: Retrospective analysis of 8 consecutive patients aged 40 to 57 years (seven males) treated for acute complications in the initial episode of a type B aortic dissection between August 2006 and July 2008. Results: Six/eight were known hypertensive patients. The indications for surgery were intractable pain in one, hypertension refractory to treatment in two and distal hypoperfusion in fve. Five patients required covering of the left subclavian artery ostium, without need for surgical repair. One patient was subjected to renal angioplasty and stenting. Technical success was achieved in all cases, with complete closure of the proximal aortic tear and thoracic aortic false lumen, although 7 of patients had a persistent distal aortic false lumen. One case had a transient lower limb paraparesis. No patient died. Conclusions: Endovascular treatment is effective in closing the aortic tear as well as the thoracic aortic false lumen in aortic type B dissections with a low complication rate. Due to the high frequency of distal aortic false lumen persistence, it is not a defnitive treatment for this condition but it is useful for the acute complications of the initial phase of type B aortic dissection.

Systemic lymphoma that involves the aorta is called periaortic lymphoma, and may be misdiagnosed clinically or in CT sean, mimicking a thoracic aortic aneurysm, dissection, penetrating ulcer or an intramural hematoma. We report a 70 year-old woman in whom a systemic non-Hodgkin 's lymphoma ivas diagnosed after she presented with the clinical features of an acute aortic syndrome. A CT sean showed the presence of a large thoracoabdominal periaortic soft tissue mass without aneurism or dissection. Later, a biopsy of the mass ivasperformed which showed a non-Hodgkin's lymphoma. Chemotherapy with CHOP-R was effective, with complete initial resolution of the mass, developing in the follow up chylothorax, malnutrition and death.

Systemic lymphoma that involves the aorta is called periaortic lymphoma, and may be misdiagnosed clinically or in CT sean, mimicking a thoracic aortic aneurysm, dissection, penetrating ulcer or an intramural hematoma. We report a 70 year-old woman in whom a systemic non-Hodgkin 's lymphoma ivas diagnosed after she presented with the clinical features of an acute aortic syndrome. A CT sean showed the presence of a large thoracoabdominal periaortic soft tissue mass without aneurism or dissection. Later, a biopsy of the mass ivasperformed which showed a non-Hodgkin's lymphoma. Chemotherapy with CHOP-R was effective, with complete initial resolution of the mass, developing in the follow up chylothorax, malnutrition and death.

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)