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Abstrak :

ABSTRACT
Purposes Vascular surgery (VS) has a higher perioperative mortality than other types of surgery. We compared different scores for predicting mortality in patients admitted to the intensive care unit (ICU) after open VS. Methods Patients admitted to the ICU after open VS from 2006 to 2013 were included. We calculated the Acute Physiology and Chronic Health Evaluation (APACHE), Simplified Acute Physiology Score (SAPS), Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) and Preoperative Score to Predict Postoperative Mortality (POSPOM). We performed multivariate logistic regression to assess independent factors with the calculation of odds ratios (ORs) and 95% confidence intervals (CIs). We tested the predictive ability of the scores using the area under the receiver operating characteristics curve (AUROC). Results A total of 833 consecutive patients were included. Hospital mortality was 5,1% (1,3% after intermediate-risk and 8,4% after high-risk surgery). In the multivariate analysis, the age (OR 1,04, 95% CI 1,01-1,08, p = 0,013), smoking status (OR 2,46, 95% CI 1,16-5,21, p = 0,019), surgery risk (OR 2,92, 95% CI 1,058,08, p = 0,040), serum sodium level (OR 1,17, 95% CI 1,10-1,26, p < 0,001), urea (OR 1,01, 95% CI 1,01-1,02, p = 0,001) and leukocyte count (OR 1,05, 95% CI 1,01-1,10, p = 0,009) at admission were considered independent predictors. Hematocrit (0,86, 95% CI 0,80-0,93, p < 0.001) was considered an independent protective factor. The AUROC of our model was 0,860, compared to SAPS (0,752), APACHE (0,774), POSPOM (0,798) and POSSUM (0,829). Conclusion The observed mortality was within the predicted range (1-5% after intermediate-risk and > 5% after high-risk surgery). POSSUM and POSPOM had slightly better predictive capacity than SAPS or APACHE.

Abstrak :
La pathologie vasculaire digestive reste méconnue. Elle est rare, protéiforme, de traitement parfois complexe. Les auteurs ont eu l’opportunité de réunir dans le même établissement de santé plusieurs médecins de spécialités différentes : anesthésistes réanimateurs, gastro-entérologues, spécialistes en médecine vasculaire, nutritionnistes, radiologues, angéiologues et chirurgiens, qui se sont impliqués dans la prise en charge de la pathologie vasculaire digestive. Ils ont réalisé un ouvrage collectif où ils font la synthèse, à la lumière de leur expérience, des dernières mises au point en pathologie vasculaire digestive. Sont abordés en particulier les ischémies intestinales aiguë et chronique, les colites et rectites ischémiques, les infarcissements veineux du grêle et du côlon, les anévrysmes et les dissections spontanées, les traumatismes ainsi que d’autres pathologies vasculaires plus rares pouvant toucher le tube digestif. Le fait de travailler en équipe depuis plusieurs années donne aux auteurs une vision globale de ce sujet qui se traduit dans l’homogénéité de l’ouvrage. L’utilisation d’une illustration abondante et didactique facilite la lecture et la compréhension.

Abstrak :
La disponibilità e la diffusione di tecnologie performanti ha determinato l’affermarsi degli studi angio-TC ed angio-RM come tecniche semplici ed affidabili per la caratterizzazione ed il planning terapeutico delle principali patologie del sistema cardiocircolatorio, la cui conoscenza è divenuta ormai obbligatoria per tutti i radiologi. Lo scopo di questo testo è di fornire indicazioni tecniche in forma sintetica, ma quanto più possibile completa, relativamente ai principi tecnici ed alla metodologia d’esame per studi angio-TC ed angio-RM di alta qualità negli scenari clinici più vari, presentando allo stesso tempo un’ampia casistica di supporto, ricca di spunti interpretativi e di suggerimenti pratici per la valutazione e la refertazione degli esami. Lo scopo del testo sarà anche di dimostrare i vantaggi ed i limiti delle due metodiche a confronto nelle diverse patologie e nei diversi distretti vascolari, in modo da fornire indicazioni al radiologo esperto ed a quello in formazione.