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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El aneurisma de aorta abdominal &#40;AAA&#41; es una dilataci&#243;n del espesor completo del di&#225;metro de la arteria que es al menos el 50&#37; de su di&#225;metro normal&#44; medido en el plano anteroposterior&#46; En hombres&#44; se define por un di&#225;metro mayor o igual a 3<span class="elsevierStyleHsp" style=""></span>cm<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">1</span></a>&#46; En el 85&#37; de los casos el AAA ocurre en el segmento infrarrenal<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">2</span></a>&#46; La prevalencia ha disminuido de forma importante en los &#250;ltimos a&#241;os hasta situarse en el 2&#44;2&#37;&#44; seg&#250;n los datos obtenidos en programas de cribado realizados a hombres mayores de 65<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; Este cambio epidemiol&#243;gico probablemente se relacione con el descenso en el consumo de tabaco<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; La rotura del AAA es responsable del 1-2&#37; de todas las muertes en varones de 65 a 85<span class="elsevierStyleHsp" style=""></span>a&#241;os en los pa&#237;ses desarrollados<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">3-6</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Los factores de riesgo que m&#225;s se relacionan con el desarrollo de AAA son el tabaquismo&#44; la edad avanzada&#44; el sexo masculino&#44; la hipertensi&#243;n arterial &#40;HTA&#41;&#44; la hipercolesterolemia y la historia familiar&#46; Por el contrario&#44; la diabetes mellitus se ha relacionado con un menor riesgo para su desarrollo<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">7&#44;8</span></a>&#46; Existen otros factores&#44; como enfermedades hereditarias del tejido conectivo &#40;s&#237;ndrome de Marfan y s&#237;ndrome de Ehlers-Danlos&#41;&#44; esclerosis tuberosa o vasculitis&#44; que son menos frecuentes y se asocian con AAA en pacientes j&#243;venes<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#44;9</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En algunos pa&#237;ses se recomienda el cribado de AAA en varones con edades comprendidas entre 65 y 75<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; sobre todo si tienen historia de tabaquismo<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">10-14</span></a>&#46; Sin embargo&#44; estudios recientes han puesto en cuesti&#243;n la utilidad real de un cribado universal de AAA en pacientes de alto riesgo<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">15</span></a>&#46; La mayor parte de los AAA diagnosticados en los programas de detecci&#243;n son de peque&#241;o tama&#241;o &#40;3-4<span class="elsevierStyleHsp" style=""></span>cm de di&#225;metro m&#225;ximo&#41; y no precisan reparaci&#243;n quir&#250;rgica de forma inminente&#44; ya que el riesgo de rotura es muy bajo &#40;&#8804;<span class="elsevierStyleHsp" style=""></span>1&#37; anual en AAA inferiores a 5&#44;5<span class="elsevierStyleHsp" style=""></span>cm&#41;&#59; sin embargo&#44; a lo largo del tiempo el tama&#241;o del AAA puede aumentar&#44; con el consiguiente incremento del riesgo anual de rotura &#40;9&#44;4&#37; en AAA entre 5&#44;5 y 5&#44;9<span class="elsevierStyleHsp" style=""></span>cm&#44; 10&#44;2&#37; en AAA entre 6&#44;0 y 6&#44;9<span class="elsevierStyleHsp" style=""></span>cm y 32&#44;5&#37; en AAA &#8805;<span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>cm&#41;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">2&#44;16&#44;17</span></a>&#46; Estudios m&#225;s recientes han notificado&#44; no obstante&#44; datos sobre el riesgo de rotura bastante inferiores a los citados anteriormente &#40;3&#44;5&#37; en AAA entre 5&#44;5 y 6&#44;0<span class="elsevierStyleHsp" style=""></span>cm&#44; 4&#44;1&#37; en AAA entre 6&#44;1 y 7<span class="elsevierStyleHsp" style=""></span>cm y 6&#44;3&#37; en AAA &#62;<span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>cm&#41;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">18&#44;19</span></a>&#44; por lo que resulta significativo que los cambios en el comportamiento del paciente en cuanto al control de factores de riesgo se traducen en una disminuci&#243;n de la mortalidad relacionada con el AAA&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">De forma independiente a la relaci&#243;n entre el tama&#241;o del AAA y su riesgo de rotura&#44; en diversos estudios se ha objetivado un mayor riesgo cardiovascular en estos pacientes<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">20-22</span></a>&#46; Se ha sugerido una posible asociaci&#243;n entre el di&#225;metro de la aorta abdominal y el riesgo de muerte&#44; aunque no se alcancen los 3<span class="elsevierStyleHsp" style=""></span>cm de di&#225;metro&#44; al igual que un mayor riesgo de desarrollar AAA en los pacientes con dilataciones subaneurism&#225;ticas<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">23-25</span></a>&#46; As&#237;&#44; la mortalidad en un estudio de cohortes prospectivo de m&#225;s de 7<span class="elsevierStyleHsp" style=""></span>a&#241;os de duraci&#243;n fue significativamente superior entre los varones con un di&#225;metro de la aorta abdominal comprendido entre 2&#44;5 y 2&#44;9<span class="elsevierStyleHsp" style=""></span>cm respecto a un di&#225;metro &#60;<span class="elsevierStyleHsp" style=""></span>2&#44;4<span class="elsevierStyleHsp" style=""></span>cm &#40;10&#44;3&#37; frente a 7&#44;2&#37;&#41;&#59; cuando el tama&#241;o de la aorta super&#243; los 3<span class="elsevierStyleHsp" style=""></span>cm&#44; la mortalidad aument&#243; al 17&#44;6&#37;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">23</span></a>&#46; Por tanto&#44; cabe la posibilidad de considerar el tama&#241;o de la aorta abdominal como un potencial marcador de riesgo cardiovascular&#44; pudiendo a&#241;adirse a las denominadas lesiones de &#243;rgano diana&#44; que determinan la existencia de da&#241;o subcl&#237;nico y se relacionan claramente con un mayor riesgo de complicaciones cardiovasculares&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Gracias a los avances tecnol&#243;gicos&#44; en los &#250;ltimos a&#241;os se han desarrollado ec&#243;grafos de gran calidad a precios asequibles&#44; port&#225;tiles o de bolsillo&#44; que permiten realizar las exploraciones a pie de cama o en la propia consulta&#44; lo que ha facilitado su empleo en diversas especialidades&#44; como la medicina interna o la medicina de familia&#46; La valoraci&#243;n ecogr&#225;fica de la aorta abdominal es sencilla y puede realizarla con fiabilidad cualquier m&#233;dico con un periodo de entrenamiento corto<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">26</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El objetivo de este estudio es doble&#58; a&#41;<span class="elsevierStyleHsp" style=""></span>determinar la prevalencia de AAA en pacientes con riesgo cardiovascular elevado o que ya hab&#237;an sufrido alguna complicaci&#243;n cardiovascular&#44; y b&#41;<span class="elsevierStyleHsp" style=""></span>valorar la relaci&#243;n del tama&#241;o de la aorta con los diferentes factores de riesgo cardiovascular y evaluar las caracter&#237;sticas espec&#237;ficas de estos pacientes&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes y m&#233;todos</span><p id="par0035" class="elsevierStylePara elsevierViewall">Estudio observacional&#44; transversal y multic&#233;ntrico en el que participaron seis unidades de medicina interna que dispon&#237;an de equipo de ecograf&#237;a y experiencia en su manejo&#46; El reclutamiento de pacientes se prolong&#243; durante 24<span class="elsevierStyleHsp" style=""></span>meses&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Para ello se incluyeron de forma no consecutiva varones mayores de 55<span class="elsevierStyleHsp" style=""></span>a&#241;os y mujeres mayores de 65<span class="elsevierStyleHsp" style=""></span>a&#241;os con riesgo cardiovascular alto o muy alto&#44; siguiendo los criterios de las gu&#237;as europeas sobre prevenci&#243;n de la enfermedad cardiovascular<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">27</span></a>&#44; que fueron identificados y reclutados de modo oportunista en los diferentes &#225;mbitos asistenciales de la medicina interna &#40;urgencia hospitalaria&#44; consulta externa y hospitalizaci&#243;n&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">La diabetes mellitus se defini&#243; como glucemia &#62;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl en cualquier momento del d&#237;a acompa&#241;ada de s&#237;ntomas de diabetes&#44; glucemia en ayunas &#8805;<span class="elsevierStyleHsp" style=""></span>126<span class="elsevierStyleHsp" style=""></span>mg&#47;dl en al menos dos determinaciones repetidas&#44; glucemia &#8805;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl a las 2<span class="elsevierStyleHsp" style=""></span>h de una sobrecarga oral de glucosa o hemoglobina glucosilada &#40;HbA1c&#41; &#8805;<span class="elsevierStyleHsp" style=""></span>6&#44;5&#37;&#46; La enfermedad renal cr&#243;nica moderada se defini&#243; como la presencia de un filtrado glomerular &#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> empleando la f&#243;rmula MDRD&#46; La presencia de microalbuminuria y proteinuria se analiz&#243; mediante el cociente alb&#250;mina&#47;creatinina en muestra &#250;nica de orina&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Los factores de riesgo cardiovascular que se registraron fueron los siguientes&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0055" class="elsevierStylePara elsevierViewall">HTA o existencia de tratamiento antihipertensivo&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Presi&#243;n de pulso elevada &#40;diferencia entre presi&#243;n sist&#243;lica y diast&#243;lica &#62;<span class="elsevierStyleHsp" style=""></span>62<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Tabaquismo &#40;fumadores activos y exfumadores&#59; cuantificaci&#243;n por paquetes&#47;a&#241;o&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Dislipemia &#40;colesterol total &#62;<span class="elsevierStyleHsp" style=""></span>190<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; colesterol LDL &#62;<span class="elsevierStyleHsp" style=""></span>115<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; colesterol HDL &#60;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; triglic&#233;ridos &#62;<span class="elsevierStyleHsp" style=""></span>150<span class="elsevierStyleHsp" style=""></span>mg&#47;dl o tratamiento hipolipemiante&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Diabetes mellitus&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Obesidad troncular&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Antecedentes familiares de enfermedad cardiovascular prematura &#40;&#60;<span class="elsevierStyleHsp" style=""></span>55<span class="elsevierStyleHsp" style=""></span>a&#241;os en varones y &#60;<span class="elsevierStyleHsp" style=""></span>65<span class="elsevierStyleHsp" style=""></span>a&#241;os en mujeres&#41;&#46;</p></li></ul></p><p id="par0090" class="elsevierStylePara elsevierViewall">El per&#237;metro de la cintura se midi&#243; con una cinta m&#233;trica inextensible en el punto medio entre el reborde costal inferior y la cresta il&#237;aca&#44; y el de la cadera a nivel de los troc&#225;nteres mayores&#46; El &#237;ndice cintura-cadera se calcul&#243; con la f&#243;rmula&#58; circunferencia de la cintura &#40;cm&#41;&#47;circunferencia de la cadera &#40;cm&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Para la medici&#243;n del di&#225;metro de la aorta abdominal se utiliz&#243; una sonda convex de baja frecuencia &#40;&#60;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>MHz&#41;&#44; explor&#225;ndose al enfermo en dec&#250;bito supino&#46; Se realizaron cortes transversales de la aorta desde la salida de las arterias renales hasta la bifurcaci&#243;n de las arterias il&#237;acas&#44; seleccion&#225;ndose los di&#225;metros anteroposterior y transversal m&#225;ximos detectados a lo largo de todo el recorrido de la aorta abdominal&#46; Se defini&#243; el AAA como la presencia de un di&#225;metro de la aorta abdominal infrarrenal &#8805;<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Se incluyeron como variables independientes la informaci&#243;n demogr&#225;fica&#44; los antecedentes personales y los signos exploratorios necesarios para establecer el riesgo vascular &#40;definidos previamente&#41;&#46; La variable dependiente fue el di&#225;metro m&#225;ximo de la aorta abdominal&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Para facilitar la inclusi&#243;n de las variables se dise&#241;&#243; un formulario en una p&#225;gina web espec&#237;fica para el estudio&#44; a la que tuvieron acceso individualizado todos los investigadores&#46; En el registro informatizado no se incluy&#243; ninguna variable que pudiera identificar al paciente&#44; cumpliendo los criterios de seguridad exigidos por la Ley Org&#225;nica de Protecci&#243;n de Datos&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Los criterios de exclusi&#243;n fueron los siguientes&#58; pacientes que no quisieron participar en el estudio y&#47;o no firmaron el consentimiento informado&#44; diagn&#243;stico de AAA previo al inicio del estudio&#44; imposibilidad para medir el di&#225;metro de la aorta abdominal&#44; pacientes diagnosticados de demencia moderada-severa o que presentaran alteraci&#243;n o trastorno del nivel de consciencia que les impidiera la firma voluntaria del consentimiento informado&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">En cuanto al an&#225;lisis estad&#237;stico&#44; las variables cuantitativas se expresaron mediante la media aritm&#233;tica y la desviaci&#243;n est&#225;ndar &#40;mediana y rango intercuartil para variables no param&#233;tricas&#41;&#44; y las variables cualitativas por su porcentaje&#46; Para el an&#225;lisis univariante se utiliz&#243; el test t de Student &#40;test de Mann&#8211;Whitney para variables no param&#233;tricas&#41; para comparar medias y la prueba de chi-cuadrado &#40;&#967;<span class="elsevierStyleSup">2</span>&#41; para comparar proporciones&#46; En el an&#225;lisis multivariante se utiliz&#243; la regresi&#243;n log&#237;stica binaria&#44; incluy&#233;ndose las variables cl&#237;nicamente significativas&#46; El estudio estad&#237;stico fue realizado mediante el programa SPSS versi&#243;n 22 &#40;SPSS&#44; Inc&#46;&#44; Chicago&#44; IL&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">El estudio fue aprobado en las diferentes comisiones de investigaci&#243;n de cada centro hospitalario y en el Comit&#233; de Ensayos Cl&#237;nicos del Hospital Universitario de Getafe&#46; Todos los pacientes incluidos firmaron el consentimiento informado&#46; Ninguna de las actuaciones realizadas en el estudio demor&#243; el diagn&#243;stico o el tratamiento de los pacientes&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0125" class="elsevierStylePara elsevierViewall">Se reclutaron un total de 688 pacientes&#44; de los que 659 &#40;95&#44;7&#37;&#41; fueron finalmente incluidos&#44; con una edad media de 71 &#40;&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;7&#41; a&#241;os&#46; Se detect&#243; la presencia de un AAA en 53 pacientes &#40;8&#37;&#41;&#44; la mayor&#237;a varones &#40;94&#44;3&#37;&#41;&#46; Las caracter&#237;sticas demogr&#225;ficas de los diferentes grupos se detallan en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; En la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> se presenta un histograma de frecuencias del di&#225;metro m&#225;ximo de la aorta abdominal en el total de pacientes incluidos en el estudio&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">El an&#225;lisis multivariante se llev&#243; a cabo mediante una regresi&#243;n log&#237;stica binaria en la que se incluyeron seis variables&#59; en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se puede observar la estimaci&#243;n de riesgo de cada una de ellas&#46; Cuatro variables demostraron su asociaci&#243;n independiente con el desarrollo de AAA&#58; edad&#44; sexo&#44; tabaquismo activo y arteriopat&#237;a perif&#233;rica&#44; siendo la diabetes mellitus un factor protector&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">Por otra parte&#44; se detectaron un total de 342 pacientes &#40;49&#44;7&#37; del total&#41; con dilataci&#243;n subaneurism&#225;tica de la aorta&#44; de los cuales 292 ten&#237;an di&#225;metros comprendidos entre 20 y 24&#44;9<span class="elsevierStyleHsp" style=""></span>mm y los 50 restantes entre 25 y 29&#44;9<span class="elsevierStyleHsp" style=""></span>mm&#46; Como puede observarse en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#44; los pacientes eran predominantemente varones&#44; m&#225;s del 65&#37; ten&#237;an antecedente de tabaquismo&#44; la mayor&#237;a ten&#237;an hipertensi&#243;n arterial y dislipemia y casi tres cuartas partes presentaban tres o m&#225;s factores de riesgo simult&#225;neos&#46; La diabetes mellitus estaba presente en m&#225;s del 60&#37; de los pacientes&#44; y los antecedentes familiares de enfermedad vascular prematura eran casi testimoniales&#46; Este perfil es similar al de los pacientes con AAA establecido&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0145" class="elsevierStylePara elsevierViewall">Los primeros estudios realizados en pa&#237;ses desarrollados mostraron una prevalencia de AAA en varones mayores de 65<span class="elsevierStyleHsp" style=""></span>a&#241;os de entre el 4 y el 7&#37;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">28&#44;29</span></a>&#46; En estudios poblacionales m&#225;s recientes &#40;incluyendo registros espa&#241;oles&#41; la prevalencia ha descendido hasta el 1-2&#37;&#44; probablemente por un mejor control de los factores de riesgo cardiovascular y la reducci&#243;n del tabaquismo en nuestro entorno<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">La prevalencia de AAA en la muestra de nuestro estudio &#40;8&#37;&#41; es superior a la registrada en trabajos similares<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">31</span></a>&#44; y probablemente se deba a que nuestra poblaci&#243;n presentaba una edad media m&#225;s elevada y una mayor prevalencia de tabaquismo y enfermedad cardiovascular establecida&#44; factores asociados a una mayor prevalencia de AAA&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Los AAA se asocian con la edad&#44; el sexo masculino&#44; el tabaquismo&#44; la hipertensi&#243;n&#44; la historia familiar de AAA y la presencia de enfermedad cardiovascular previa&#44; en especial la cardiopat&#237;a isqu&#233;mica<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">32</span></a>&#46; En nuestro estudio&#44; la edad y el sexo masculino fueron las variables demogr&#225;ficas asociadas a un mayor riesgo de la enfermedad&#59; a partir de los 67-68<span class="elsevierStyleHsp" style=""></span>a&#241;os se detectan el 75-80&#37; de los AAA&#46; La diabetes mellitus&#44; al igual que en otras publicaciones&#44; se erigi&#243; como un factor protector para el desarrollo de AAA&#59; se ha planteado la posibilidad de que la glucosilaci&#243;n de las mol&#233;culas de la matriz extracelular y el consiguiente aumento de su resistencia a la prote&#243;lisis pueda desempe&#241;ar un papel clave en esta relaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">33</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Dentro de los factores de riesgo cardiovascular y lesi&#243;n de &#243;rganos diana&#44; solo el consumo de tabaco y la arteriopat&#237;a perif&#233;rica mostraron una asociaci&#243;n independiente con la presencia de AAA&#59; es probable que el motivo sea la falta de potencia estad&#237;stica del modelo en relaci&#243;n con el tama&#241;o muestral&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Aunque no era uno de los objetivos de este estudio y&#44; por tanto&#44; no se ha profundizado en ello&#44; se han analizado las caracter&#237;sticas de los pacientes con dilataci&#243;n subaneurism&#225;tica de la aorta &#40;di&#225;metro a&#243;rtico entre 25-29&#44;9<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; advirti&#233;ndose que los factores de riesgo presentes en ellos son muy similares a los de los pacientes con AAA establecido&#46; La historia natural de esas aortas &#171;anormales&#187; indica que m&#225;s de un 50&#37; progresan a AAA en 5<span class="elsevierStyleHsp" style=""></span>a&#241;os<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">34</span></a>&#46; Aunque actualmente no pueden efectuarse recomendaciones firmes para el cribado peri&#243;dico a esta poblaci&#243;n&#44; en algunos programas se incluye la realizaci&#243;n de una nueva ecograf&#237;a a los 5<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; una estrategia que est&#225; siendo revisada por el <span class="elsevierStyleItalic">National Health Service Abdominal Aortic Aneurysm Screening Programme</span> &#40;NAAASP&#41;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">35</span></a>&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Un aspecto relevante sobre el que nos gustar&#237;a hacer &#233;nfasis es la utilidad de la ecograf&#237;a abdominal realizada por generalistas en la detecci&#243;n del AAA en el subgrupo de pacientes en los que el riesgo vascular es m&#225;s elevado&#46; Dado que se trata de una prueba relativamente sencilla e inocua y que no requiere un periodo de formaci&#243;n largo&#44; puede llevarse a cabo a pie de cama durante la hospitalizaci&#243;n o en la consulta externa en pacientes ambulatorios&#46; Tal y como se desprende del trabajo de Sis&#243;-Almirall et al&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">36</span></a> acerca de la ecograf&#237;a en atenci&#243;n primaria para la detecci&#243;n del AAA&#44; es posible que en un futuro no muy lejano el cribado de esta patolog&#237;a pueda llevarse a cabo en los centros de salud por parte de los m&#233;dicos de familia&#44; remitiendo al paciente&#44; en caso de indicaci&#243;n quir&#250;rgica&#44; a la consulta de angiolog&#237;a y cirug&#237;a vascular&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">El estudio tiene sus limitaciones&#44; como las variaciones dependientes del observador cuando realiza la ecograf&#237;a&#44; a pesar de que el procedimiento no presenta grandes dificultades en su interpretaci&#243;n&#46; Adicionalmente&#44; el m&#233;todo de medida no se encuentra estandarizado en los diferentes programas de cribado<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a>&#46; Por otro lado&#44; la diversa procedencia que presenta la poblaci&#243;n&#44; concentrada en nivel de riesgo vascular identificado de modo oportunista&#44; hace dif&#237;cil la comparaci&#243;n con otros &#225;mbitos asistenciales bien definidos&#46; Al tratarse de una poblaci&#243;n seleccionada de alto o muy alto riesgo vascular&#44; los resultados no son extrapolables al resto de la poblaci&#243;n&#46; Finalmente&#44; es necesario dise&#241;ar estudios dirigidos a la detecci&#243;n de pacientes con dilataciones subaneurism&#225;ticas de la aorta que confirmen los resultados obtenidos en esta subpoblaci&#243;n y la necesidad de cribado&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">En definitiva&#44; en ausencia de una pol&#237;tica sistem&#225;tica de cribado en nuestro medio&#44; los hallazgos de este trabajo reivindican la importancia de una aproximaci&#243;n oportunista del cribado de AAA en pacientes de alto y muy alto riesgo cardiovascular&#44; en particular varones mayores de 65<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; fumadores y con historia de enfermedad arterial perif&#233;rica&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicto de intereses</span><p id="par0185" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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            0 => "Aneurisma de aorta abdominal"
            1 => "Dilataci&#243;n a&#243;rtica subaneurism&#225;tica"
            2 => "Ecograf&#237;a"
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            0 => "Abdominal aortic aneurysm"
            1 => "Subaneurysmal aortic dilatation"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Determinar la prevalencia de aneurisma de aorta abdominal &#40;AAA&#41;&#44; definido por un di&#225;metro arterial &#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>mm&#44; en pacientes con alto o muy alto riesgo cardiovascular &#40;RCV&#41; y evaluar sus caracter&#237;sticas cl&#237;nicas&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional&#44; transversal y multic&#233;ntrico realizado en servicios de Medicina Interna del pa&#237;s a varones con edad &#62;<span class="elsevierStyleHsp" style=""></span>55<span class="elsevierStyleHsp" style=""></span>a&#241;os y mujeres &#62;<span class="elsevierStyleHsp" style=""></span>65<span class="elsevierStyleHsp" style=""></span>a&#241;os que ten&#237;an un RCV alto o muy alto reclutados durante 24<span class="elsevierStyleHsp" style=""></span>meses&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 659 pacientes&#46; La prevalencia de AAA fue del 8&#37; &#40;53 pacientes&#41;&#46; El 76&#44;9&#37; fueron varones&#44; con edad media de 71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;7<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; El an&#225;lisis multivariante demostr&#243; asociaci&#243;n entre AAA y la edad &#40;OR&#58; 1&#44;06&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;02-1&#44;1&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; el sexo masculino &#40;OR&#58; 5&#44;6&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;6-18&#44;8&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; el tabaquismo activo &#40;OR&#58; 3&#44;22&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;16-8&#44;93&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;024&#41; y la arteriopat&#237;a perif&#233;rica &#40;OR&#58; 3&#44;51&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;73-7&#44;09&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; siendo la diabetes mellitus un factor protector independiente &#40;OR&#58; 0&#44;41&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;22-0&#44;78&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;06&#41;&#46; Los pacientes con dilataci&#243;n subaneurism&#225;tica de la aorta &#40;di&#225;metro de la aorta abdominal 25-29&#44;9<span class="elsevierStyleHsp" style=""></span>mm&#41; presentaban similares caracter&#237;sticas que los pacientes con AAA&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La prevalencia de AAA en pacientes de alto RCV es elevada&#46; El cribado ecogr&#225;fico puede ser realizado por m&#233;dicos generalistas&#46; Pueden beneficiarse de un cribado oportunista los varones de m&#225;s de 65<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; con RCV elevado&#44; especialmente si presentan tabaquismo activo o arteriopat&#237;a perif&#233;rica&#46;</p></span>"
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            "titulo" => "Pacientes y m&#233;todos"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To determine the prevalence of abdominal aortic aneurysm &#40;AAA&#41; &#40;arterial diameter &#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; in patients with high or very high cardiovascular risk &#40;CVR&#41; and to evaluate their clinical features&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Observational&#44; cross-sectional and multicentric study conducted in Spanish Internal Medicine Services&#46; We enrolled men with age &#62;<span class="elsevierStyleHsp" style=""></span>55<span class="elsevierStyleHsp" style=""></span>years and women &#62;<span class="elsevierStyleHsp" style=""></span>65<span class="elsevierStyleHsp" style=""></span>years who had a high or very high CVR&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The study included 659 patients&#46; The prevalence of AAA was 8&#37; &#40;53 patients&#41;&#46; 76&#46;9&#37; were male with a mean age of 71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;7<span class="elsevierStyleHsp" style=""></span>years&#46; The multivariate analysis showed an association between AAA and age &#40;OR&#58; 1&#46;06&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 1&#46;02-1&#46;1&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#44; male sex &#40;OR&#58; 5&#46;6&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 1&#46;6-18&#46;8&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#44; active smoking &#40;OR&#58; 3&#46;22&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 1&#46;16-8&#46;93&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;024&#41; and peripheral arterial disease &#40;OR&#58; 3&#46;51&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 1&#46;73-7&#46;09&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46; Diabetes mellitus was an independent protective factor &#40;OR&#58; 0&#46;41&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 0&#46;22-0&#46;78&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;06&#41;&#46; Those with subaneurysmal dilatation of the abdominal aorta &#40;diameter 25-29&#46;9<span class="elsevierStyleHsp" style=""></span>mm&#41; presented similar features as patients with AAA&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The prevalence of AAA in patients with high CVR is high&#46; Ultrasound screening can be performed by general practitioners&#46; Men &#62;<span class="elsevierStyleHsp" style=""></span>65<span class="elsevierStyleHsp" style=""></span>years with elevated CVR could benefit&#44; particularly in the presence of active smoking or peripheral arterial disease&#46;</p></span>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">AA&#58; aorta abdominal&#59; AAA&#58; aneurisma de aorta abdominal&#59; AF&#58; antecedentes familiares&#59; AP&#58; anteroposterior&#59; DM&#58; diabetes mellitus&#59; EVP&#58; enfermedad vascular prematura&#59; FA&#58; fibrilaci&#243;n auricular&#59; FG&#58; Filtrado glomerular estimado&#59; FR&#58; factores de riesgo&#59; HTA&#58; hipertensi&#243;n arterial&#59; IMC&#58; &#237;ndice de masa corporal&#59; T&#58; transversal&#46;</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">&#42; Mediana &#40;rango intercuartil&#41;&#46;</p>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">606&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mujeres&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;5&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">149 &#40;24&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Tabaquismo &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">428 &#40;64&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44 &#40;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">384 &#40;63&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Exfumadores</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">325 &#40;49&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 &#40;54&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">296 &#40;48&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Fumadores activos</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">103 &#40;15&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;28&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88 &#40;14&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Exposici&#243;n acumulada &#40;n&#250;mero de paquetes-a&#241;o&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&#44;3 &#177; 32&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&#44;9 &#177; 30&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&#44;6 &#177; 31&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Consumo de alcohol &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">182 &#40;27&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;28&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">167 &#40;27&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0913&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">HTA &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">596 &#40;90&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 &#40;94&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">546 &#40;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;464&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">DM &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">354 &#40;53&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 &#40;33&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">333 &#40;54&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Dislipemia &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">621 &#40;94&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 &#40;94&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">571 &#40;94&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;750&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">FA &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91 &#40;13&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;13&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">84 &#40;13&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;545&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Enfermedad cerebrovascular &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">122 &#40;18&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;16&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">113 &#40;18&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;765&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Cardiopat&#237;a isqu&#233;mica &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">233 &#40;35&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;45&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">208 &#40;34&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;115&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Arteriopat&#237;a perif&#233;rica &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74 &#40;11&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;30&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37 &#40;6&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">FG estimado &#40;ml&#47;min&#47;1&#44;73 m</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&#44;5 &#177; 27&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73&#44;1 &#177; 25&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&#44;9 &#177; 27&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;218&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Estadios funci&#243;n renal</span></td><td class="td" title="table-entry  " align="left" valign="top">0&#44;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FG &#62; 60 ml&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">494 &#40;75&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37 &#40;69&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">457 &#40;75&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FG 59-30 ml&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">138 &#40;20&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;24&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">125 &#40;20&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FG &#60; 30 ml&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;4&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;5&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;4&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Retinopat&#237;a avanzada &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;3&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;3&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;459&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">&#8805; 3 FR simult&#225;neos &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">534 &#40;73&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40 &#40;75&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">447 &#40;73&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;786&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">IMC</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#44;9 &#177; 4&#44;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#44;3 &#177; 5&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#177; 4&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;348&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">&#205;ndice cintura-cadera</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#177; 0&#44;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;01 &#177; 0&#44;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;99 &#177; 0&#44;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;467&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">&#193;cido &#250;rico &#40;mg&#47;dl&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#177; 1&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;9 &#177; 1&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#177; 1&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;620&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Cociente alb&#250;mina&#47;creatinina &#40;mg&#47;g&#41;</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">&#42;</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;3&#8211;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;5&#8211;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;3&#8211;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;281&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Presencia de microalbuminuria &#40;&#62;30 mg&#47;g creatinina&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">155 &#40;23&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;26&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">141 &#40;23&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Di&#225;metro AP m&#225;ximo AA &#40;m&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;9&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45 &#40;74&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;L&#46; Chaikof"
                            1 => "R&#46;L&#46; Dalman"
                            2 => "M&#46;K&#46; Eskandari"
                            3 => "B&#46;M&#46; Jackson"
                            4 => "W&#46;A&#46; Lee"
                            5 => "M&#46;A&#46; Mansour"
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                    0 => array:2 [
                      "doi" => "10.1016/j.jvs.2017.10.044"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Vasc Surg&#46;"
                        "fecha" => "2018"
                        "volumen" => "67"
                        "paginaInicial" => "2"
                        "paginaFinal" => "77"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29268916"
                            "web" => "Medline"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Abdominal aortic aneurysm"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "K&#46; Craig Kent"
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                        ]
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                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1056/NEJMcp1401430"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med&#46;"
                        "fecha" => "2014"
                        "volumen" => "371"
                        "paginaInicial" => "2101"
                        "paginaFinal" => "2108"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25427112"
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