Resumo Desde que a pandemia pelo novo coronavírus se estabeleceu na Espanha, em março de 2020, um aumento notável da incidência de isquemia aguda de membros foi observado. Recentemente, descobriu-se que o coronavírus 2 causador da síndrome respiratória aguda grave (SARS-CoV-2) pode ocasionar isquemia aguda de membros secundária à trombose arterial. A elevação do D-dímero em pacientes acometidos pela doença do novo coronavírus (COVID-19) indica o estado de hipercoagulabilidade como causa da trombose arterial aguda. Vale destacar que a alta elevação do D-dímero foi relatada como um fator de prognóstico reservado na COVID-19. Há diversas maneiras pelas quais o SARS-CoV-2 pode resultar em trombose arterial. Em pacientes com COVID-19, a revascularização cirúrgica para isquemia aguda de membros está associada a desfechos desfavoráveis, provavelmente relacionados a hipercoagulabilidade. Descrevemos dois casos de isquemia aguda de membros de pacientes que necessitaram de tratamento cirúrgico de urgência para salvamento de membro e que haviam testado positivo para COVID-19.

Abstract Since the coronavirus pandemic set in in Spain in March 2020, a noteworthy increase in the incidence of acute limb ischemia (ALI) has been observed. It has been recently discovered that SARS-CoV 2 may lead to ALI secondary to arterial thrombosis. Elevation of D-dimer (DD) in patients with coronavirus infection (COVID-19) indicates that a hypercoagulable state causes acute arterial thrombosis. A remarkably high DD elevation has been reported to be a poor prognosis factor in COVID-19. The ways in which SARS-CoV 2 results in arterial thrombosis may be multiple. On the other hand, surgical revascularization for ALI is associated with poor outcomes in COVID-19 patients, probably in relation to hypercoagulability. Here, we describe two ALI cases in patients who required urgent surgical treatment for limb salvage and were positive for the novel coronavirus infection (COVID 19).

Abstract A ruptured abdominal aortic aneurysm (rAAA) is a highly lethal event remaining associated with a high overall mortality, in spite of the reduction in the mortality from rAAA over the last two decades linked with the adoption of an endovascular aneurysm repair (EVAR) as the forefront strategy, as well as the advances in perioperative critical care practices. Management of a rAAA can be divided into four stages: diagnosis, perioperative management, surgical repair and postoperative period. Within the framework of American and European clinical practice guidelines on the management of abdominal aortic aneurysms and NICE guideline, all of them recently published, updated critical issues for each stage are shown. From the key role of CT angiogram for the diagnosis to the postoperative complications, such as abdominal compartment syndrome The creation of evidence-based protocols and algorithms for rapid diagnosis and treatment aids to make decisions and at the same time it will reduce the time since diagnosis to control of hemorrhage, which is essential for survival.

Resumen La rotura de un aneurisma aórtico abdominal (AAA) es un evento altamente letal que continúa asociada a una alta mortalidad, a pesar de su disminución en las últimas dos décadas, asociada a la adopción de la cirugía endovascular como primera línea de tratamiento y a avances en el manejo anestésico y perioperatorio. La actuación frente a un AAA roto (AAAr) puede dividirse en cuatro etapas: diagnóstico, manejo perioperatorio, cirugía y posoperatorio. En el marco de las guías americana y europea sobre manejo de AAAr y de la Guía NICE, se expone una actualización de los puntos críticos en cada etapa: desde el papel diagnóstico clave del angio-TAC hasta el manejo de complicaciones posoperatorias, como el síndrome compartimental abdominal. La creación de protocolos y algoritmos basada en la evidencia ayuda en la toma de decisiones y disminuye el tiempo desde el diagnóstico hasta el control hemorrágico, esencial para la supervivencia.