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Del Blanco Alonso I, Revilla Calavia Á, Saiz-Viloria L, Diez Martínez M, San Norberto García E, Vaquero Puerta C. Cost-effectiveness analysis of the diagnosis of temporal arteritis. Reumatol Clin (Engl Ed) 2024; 20:181-186. [PMID: 38614886 DOI: 10.1016/j.reumae.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 11/22/2023] [Accepted: 12/14/2023] [Indexed: 04/15/2024]
Abstract
Temporal arteritis (TA) is the most common form of systemic vasculitis. Its diagnosis is based on criteria proposed by the American College of Rheumatology (1990), and its treatment is high-dose corticosteroids. Our objective is to assess the cost of diagnosing TA, and secondarily, cost-effective analysis of different diagnostic strategies (clinical, biopsy, doppler ultrasound) and therapeutic strategies (corticosteroid suspension). MATERIAL AND METHOD Observational, retrospective study has been carried out on patients with AT (2012-2021). Demographic data, comorbidities, signs and symptoms suggestive of AT were collected. AT was diagnosed with a score ≥ 3 according to American College of Rheumatoloy criteria (ACR-SCORE). The costs of diagnosis and treatment modification were analysed. RESULTS Seventy-five patients have been included, median age 77 (46-87) years. Headache, temporal pain and jaw claudication were significant for the diagnosis of TA. Patients with a halo on Doppler ultrasound and a positive biopsy have significantly elevated ESR and CRP compared to patients who do not. The cost of the AT diagnosis was 414.7 euros/patient. If we use ACR-SCORE ≥ 3-echodoppler it is 167.2 є/patient (savings 59.6%) and ACR-SCORE ≥ 3-biopsy 339.75 є/patient (savings 18%). If the corticosteroid was removed and a biopsy was performed, 21.6 є/patient (94.7% savings), if the corticosteroid was removed and Doppler ultrasound was performed, 10.6 є/patient (97.4% savings). CONCLUSIONS Headache, temporary pain and jaw claudication are predictors of AT. Elevated ESR and CRP are predictors of positive biopsy and presence of halo on ultrasound. The uses of ACR-SCORE ≥ 3 with Doppler ultrasound or biopsy, and with corticosteroid suspension, are cost-effective.
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Affiliation(s)
- Isabel Del Blanco Alonso
- Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
| | - Álvaro Revilla Calavia
- Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Laura Saiz-Viloria
- Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Manuel Diez Martínez
- Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Carlos Vaquero Puerta
- Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Brizuela Sanz JA, García Rivera E, Hernández Crespo C, Vaquero Puerta C. Off-Label Use of a Flared Endograft Limb for Treatment of a Complicated Anastomotic Abdominal Aortic Pseudoaneurysm: Reverse Deployment Throught Axillary Artery. Ann Vasc Surg 2021; 75:532.e1-532.e4. [PMID: 33836236 DOI: 10.1016/j.avsg.2021.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/21/2021] [Accepted: 03/11/2021] [Indexed: 11/17/2022]
Abstract
A case of complicated abdominal aortic pseudoaneurysm not suitable for open repair is described. It was treated by means of endovascular methods with a flared endograft limb. The uniqueness of this case is the absence of a suitable femoral access, requiring the deployment of the graft in a reversed configuration through axillary artery. The technique is described and the need of imaginative off label use of endovascular devices in such emergent cases is discussed.
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Affiliation(s)
- José Antonio Brizuela Sanz
- Angiology and Vascular Surgery Department, Hospital Clínico Universitario de Valladolid, Universidad de Valladolid, Valladolid, Spain.
| | - Elena García Rivera
- Angiology and Vascular Surgery Department, Hospital Clínico Universitario de Valladolid, Universidad de Valladolid, Valladolid, Spain
| | - Cristian Hernández Crespo
- Angiology and Vascular Surgery Department, Hospital Clínico Universitario de Valladolid, Universidad de Valladolid, Valladolid, Spain
| | - Carlos Vaquero Puerta
- Angiology and Vascular Surgery Department, Hospital Clínico Universitario de Valladolid, Universidad de Valladolid, Valladolid, Spain
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Fabiani MA, Gonzalez-Urquijo M, Cassagne G, Dominguez A, Hinojosa-Gonzalez DE, Lozano-Balderas G, Cisneros Tinoco MÁ, Escotto Sanchez I, Esperón Percovich A, Vegas DH, Mariné Massa L, Mertens RA, Morelli L, Sepulveda Monsalve G, Sanchez Nicolat N, Perez Damian V, Riambau V, Vaquero Puerta C, Zaefferer P. Thirty-three vascular residency programs among 13 countries joining forces to improve surgical education in times of COVID-19: A survey-based assessment. Vascular 2021; 30:146-150. [PMID: 33541247 DOI: 10.1177/1708538121991268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Academic interaction with mentors has almost become minimal due to the current pandemic of COVID-19. The objective of this study is to introduce how a group of vascular surgery residencies joined forces to improve surgical education in times of COVID-19. METHODS On May 2020, a group of Hispanic American vascular residency programs created webinar sessions of arterial and venous clinical cases among vascular residents across Latin America and Europe. Participants were surveyed via email. Questions were about the perceived quality and utility of the webinars; answers were stratified into negative (disagree), neutral, and positive (agree). RESULTS There have been 60 sessions and 118 clinical cases presented. The survey was answered by 106 participants, 82 males (78.8%) and 24 women (23.0%). Fifty-four (51.9%) were board-certified vascular surgeons, 49 (47.1%) vascular surgery residents, and 2 (1.9%) general surgery residents. Mean age of the participants was 41.5 years (range: 25-74 years). Mean years of vascular surgery practice or experience were 11.2 years (range: 0-45 years). The residency programs involved in this project were from 13 different countries. Most answers received were positive for both perceived quality and utility of the webinars. CONCLUSION Globalization and technology provide an opportunity for international education, with the goal of building well-rounded and academic vascular surgeons. This group is just the beginning of a large collaborative group among Hispanic American countries, hoping that more residency programs will join, with the aim of breaking borders in the education of vascular surgery.
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Affiliation(s)
| | | | - Gabriela Cassagne
- Tecnologico de Monterrey, School of Medicine and Health Sciences, México
| | - Angeles Dominguez
- Tecnologico de Monterrey, School of Medicine and Health Sciences, México
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García Rivera E, Cenizo Revuelta N, Fidalgo Domingos L, Vaquero Puerta C. Celiac trunk segmental arterial mediolysis: a rare cause of arteriopathy. Rev Esp Enferm Dig 2020; 113:67-68. [PMID: 33207894 DOI: 10.17235/reed.2020.7143/2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 50-year-old male patient, without a previous medical history, presented sudden severe abdominal pain with no alterations in the blood analysis. A CT-Angiography (CTA) was performed that showed a wall thickening of the celiac trunk extended to the hepatic artery with a filiform lumen and no involvement of the splenic artery. There were no signs of intestinal or liver ischemia, therefore no further radiological tests were performed. The proteinogram and serology were normal, with no immunological and acute phase reactant markers, excluding vasculitis. It appeared as an isolated lesion with no signs of arterial dissection or pseudoaneurysms of the remaining abdominal vessels or the aorta. Therefore, it was considered as a Segmental Arterial Mediolisis (SAM).
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Affiliation(s)
- Elena García Rivera
- Angiología y Cirugía Vascular, Hospital Clínico Universitario de Valladolid, España
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Fidalgo Domingos L, Martin Pedrosa M, Fuente Garrido R, Revilla Calavia Á, Vaquero Puerta C. Endovascular treatment of a descending thoracic aortic aneurysm secondary to Listeria Monocytogenes. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.19.04999-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Fidalgo Domingos L, Martín Pedrosa M, Vaquero Puerta C. TAVI: iatrogenic aortic dissection during balloon retrieval. ACTA ACUST UNITED AC 2020; 73:766. [PMID: 32139283 DOI: 10.1016/j.rec.2020.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/23/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Liliana Fidalgo Domingos
- Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
| | - Miguel Martín Pedrosa
- Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Carlos Vaquero Puerta
- Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Rivera EG, Fernández IE, Domingos LF, Revuelta NC, San Norberto García EM, Pedrosa MM, Calavia ÁR, Puerta CV. Floating Thoracic and Abdominal Aortic Thrombus: Endovascular Solutions to Unexpected Findings. A Minimal Invasive Treatment With a High Primary Success. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Del Río Solá ML, Puerta CV. Effectiveness of the Combined Treatment of Functional Electrical Stimulation and Deambulation in Diabetic Arteriopathy. Ann Vasc Surg 2019; 61:83-90. [PMID: 31382005 DOI: 10.1016/j.avsg.2019.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/26/2019] [Accepted: 05/02/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine whether functional electrical stimulation (FES) is able to improve ischemic pain and quality of life of patients with diabetic arteriopathy (DA) in grade-IIa Leriche-Le Fontaine. MATERIAL AND METHODS This is a single-blinded, randomized, prospective cohort study. We included patients diagnosed with grade-IIa Leriche-Le Fontaine peripheral arterial disease in both lower extremities with and without diabetes mellitus (DM). The ankle-brachial index was 0.4-0.9. Patients were randomized into two experimental groups: nondiabetic (non-DM) (n = 71) and diabetic (DM) (n = 71). The patients received FES while walking for 1 hr on a supervised treadmill. Three months of follow-up were conducted after treatment. RESULTS A total of 168 patients were randomized; 142 completed the study, with 71 in each group. Both groups reported an improvement after the treatment, but the improvement was statistically significant in the DM group, in which all the parameters studied improved. Greater benefits were observed in all the parameters in the DM group after the follow-up, except for the test of the meters walked in 6 min. CONCLUSIONS The use of FES during daily walking is effective in patients with DA, reducing intermittent claudication and improving the quality of life of these patients.
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Fabiani MA, González-Urquijo M, Riambau V, Vaquero Puerta C, Mosquera Arochena NJ, Varona Frolov S, Maldonado TS. EVAR Approach for Abdominal Aortic Aneurysm with Horseshoe Kidney: A Multicenter Experience. Ann Vasc Surg 2019; 58:232-237. [PMID: 30731220 DOI: 10.1016/j.avsg.2018.10.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/15/2018] [Accepted: 10/25/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Horseshoe kidney is a congenital abnormality, with an incidence of 0.25% of the total population. Only 0.12% of patients who undergo an abdominal aortic aneurysm repair might also have a coexisting horseshoe kidney. We present a series of 10 cases auspiciously treated with an endovascular approach along with their respective patient evolutions. A review of the literature is also presented. MATERIALS AND METHODS A retrospective review of the medical records (January 2004-December 2013) of 10 patients with abdominal aortic aneurysms and horseshoe kidney treated with endovascular repair was done. Patients were treated at 6 different centers in 3 different countries. Demographics, clinical status, medical history, anatomical morphology of the aneurysms and kidneys, as well as surgical outcomes were all analyzed. RESULTS The median age was 67.5 years (range 47-81), and the median aortic aneurysmal diameter was 57 mm (49-81 mm). A total of 35 arteries provided renal perfusion. There were 13 right renal arteries and 13 left renal arteries, all successfully preserved, with 9 isthmus arteries covered. Median hospital stay consisted of 3.5 days (1-14 days). All aortic aneurysms were successfully excluded with no endoleaks, hematomas, wound infections, or renal failure. During a median follow-up of 7 years, 3 patients died of myocardial infarction 7 years after endovascular aortic repair (EVAR), and the other 7 patients are doing well, with a median aneurysm reduction size sac of 16.5 mm. CONCLUSIONS Endovascular repair is a safe and efficient endovascular option for the treatment of patients presenting concomitant aortic aneurysm and horseshoe kidney, with excellent short- and medium-term outcomes. To our knowledge, our study represents the largest series of cases with horseshoe kidney successfully treated via EVAR without significant complications.
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Affiliation(s)
| | | | - Vicente Riambau
- Universidad de Barcelona, Hospital Clínic of Barcelona, Barcelona, Spain
| | | | | | - Serguey Varona Frolov
- Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
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10
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Gómez López JR, Martín Del Olmo JC, Montenegro Martín MA, Concejo Cutoli P, Martín Esteban ML, Toledano Trincado M, López Mestanza IC, Vaquero Puerta C. Laparoscopic Appendectomy in the Setting of Clinical Prediction Rules. J Laparoendosc Adv Surg Tech A 2018; 29:184-191. [PMID: 30585754 DOI: 10.1089/lap.2018.0707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Acute appendicitis (AA) is the most frequent surgical entity in the emergency department, but its correct diagnosis remains challenging. To improve diagnosis, clinical prediction rules (CPRs) have been created to establish objective scores for the probability of suffering AA. In this study, we establish scores indicating whether laparoscopy would be superior to clinical observation or repeat diagnostic test. METHODS A retrospective observational study was conducted with 433 patients submitted to surgery for suspected AA using a laparoscopic approach. The Alvarado, Raja Isteri Pengiran Anak Saleha Appendicitis, appendicitis inflammatory response, and adult appendicitis score scales were applied in each case to establish a high, medium, or low probability of suffering AA. RESULTS Of the 433 patients analyzed, 381 (88.0%) had AA. Twelve (2.8%) were converted to open surgery, and complications were observed in 54 (12.5%) cases. The CPRs studied showed statistically significant differences between AA and negative appendectomies. However, in patients with intermediate probability scores, the diagnostic accuracy of the CPRs evaluated was not adequate. CONCLUSIONS Laparoscopic surgery can serve as a diagnostic tool for patients with intermediate AA probability scores because of its low associated morbidity and mortality and because it affords a direct diagnosis of the problem, allowing determination of the appropriate treatment.
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11
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Del Río Solá ML, Vaquero Puerta C. A Unique Case of Horner's Syndrome Following Subintimal Haematoma Within an Atherosclerotic Plaque. Neuroophthalmology 2018; 42:299-301. [PMID: 30258476 DOI: 10.1080/01658107.2017.1407945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/13/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022] Open
Abstract
Background and Importance We describe a patient with Horner's syndrome caused by an extensive intraparietal hematoma in the wall of the internal carotid artery confused with an arterial dissection. Detection of such pathology instead of dissection or arteritis is important as the management is different. As far as the authors know, it is the first case in which a haematoma within an atherosclerotic plaque is clinically related Horner's syndrome. Clinical Presentation A 81-year-old man presented with acute right hemiplegia and loss of vision of the left eye due to a central retinal artery occlusion. The patient underwent a computerised angiotomography which demonstrated left internal carotid artery occlusion with recanalisation after carotid bifurcation. Clinically, the patient developed a syndrome of Claude-Bernard Horner which replaced the diagnosis on the suspicion that it was a carotid artery dissection. The patient had miosis and ptosis of left eye. In the magnetic resonance angiography, an intramural of a possible hematoma was observed. It was decided to perform surgical treatment of the carotid lesion. Conclusion As this clinical case shows, there are symptomatic courtships that must be studied in detail so as not to confuse the carotid dissection with critical stenosis of the internal carotid artery.
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Brunkwall J, Vaquero Puerta C, Heckenkamp J, Egaña Barrenechea JM, Szopinski P, Mertikian G, Seifert S, Rümenapf G, Buz S, Assadian A, Majd P, Mylonas S, Revilla Calavia A, Theis T, de Blas Bravo M, Pleban E, Schupp J, Esche M, Kocaer C, Hirsch K, Oberhuber A, Schäfer JP. Prospective study of the E-liac Stent Graft System in patients with common iliac artery aneurysms: 30-Day results. Vascular 2018; 26:647-656. [PMID: 30037302 DOI: 10.1177/1708538118789510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To study the safety and feasibility of the E-liac Stent Graft System® in patients with aorto/iliac aneurysms. METHODS A prospective multicentric European registry of patients receiving the E-liac Stent Graft System® was conducted. Endpoints of the study included the technical success as well as periprocedural events and 30-day endoleaks, reinterventions, internal and external iliac artery patency and mortality. RESULTS Between July 2014 and June 2016, a total of 45 patients (93% men, mean age 72 years, range 53-90 years) were enrolled at 11 sites in four European countries. Five patients received an isolated iliac treatment. Thirty-seven patients were treated with a combination of an abdominal stent graft and a unilateral E-liac and three in combination with bilateral E-liac. All E-liac Stent Grafts (48) were implanted in the intended position and the internal iliac arteries were successfully bridged. Two patients did not receive clinical success, due to endoleak type Ia of the aortic stent graft. At 30-day follow-up, clinical success rate was 96%. Three successful endovascular reinterventions were performed within the 30-day follow-up: one due to a type Ia endoleak in the common iliac artery, one due to type Ia endoleak of the aortic stent graft, and one due to bilateral lower limb claudication provoked by stent graft limb stenosis. At 30-day, a 100% survival rate and complete absence of pelvic or buttock ischemia/claudication were reported. Primary patency at 30 days was 100% for the internal iliac artery and 98% for the external iliac artery with an assisted patency of 100% in the latter. CONCLUSIONS The high clinical success rate, low rates of device-related reinterventions (2%), and excellent patency rate demonstrate the safety and feasibility of the E-liac Stent Graft System. Long-term results are awaited to state efficacy and durability. Clinical Trials.gov. Identifier no. NCT02209194.
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Affiliation(s)
- Jan Brunkwall
- 1 Clinic of Vascular and Endovascular Surgery, University Clinic of Cologne, Cologne, Germany
| | | | - Joerg Heckenkamp
- 3 Department of Vascular and Endovascular Surgery, Marienhospital, Osnabrück, Germany
| | | | - Piotr Szopinski
- 5 Clinic of Vascular Surgery, Institute of Haematology and Transfusion Medicine, Warsaw, Poland
| | - Gerard Mertikian
- 6 Department of Interventional Radiology, Hietzing Hospital, Vienna, Austria
| | - Sven Seifert
- 7 Klinik für Thorax-, Gefäß- und endovaskuläre Chirurgie, Klinikum Chemnitz gGmbH, Germany
| | - Gerhard Rümenapf
- 8 Department of Vascular Surgery, Diakonissen Speyer-Mannheim Hospital, Speyer, Germany
| | - Semih Buz
- 9 Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - Payman Majd
- 1 Clinic of Vascular and Endovascular Surgery, University Clinic of Cologne, Cologne, Germany
| | - Spyridon Mylonas
- 1 Clinic of Vascular and Endovascular Surgery, University Clinic of Cologne, Cologne, Germany
| | | | - Thorsten Theis
- 3 Department of Vascular and Endovascular Surgery, Marienhospital, Osnabrück, Germany
| | - Mariano de Blas Bravo
- 4 Department of Vascular Surgery, Donostia University Hospital, San Sebastián, Spain
| | - Eliza Pleban
- 5 Clinic of Vascular Surgery, Institute of Haematology and Transfusion Medicine, Warsaw, Poland
| | - Jasper Schupp
- 11 Department of Radiology, University of Kiel, Kiel, Germany
| | - Mirko Esche
- 7 Klinik für Thorax-, Gefäß- und endovaskuläre Chirurgie, Klinikum Chemnitz gGmbH, Germany
| | - Cetin Kocaer
- 8 Department of Vascular Surgery, Diakonissen Speyer-Mannheim Hospital, Speyer, Germany
| | | | - Alexander Oberhuber
- 12 Department of Vascular and Endovascular Surgery, University of Düsseldorf, Germany
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Fidalgo Domingos L, San Norberto García EM, Gutiérrez Castillo D, Flota Ruiz C, Estévez Fernández I, Vaquero Puerta C. Radioprotection Measures during the Learning Curve with Hybrid Operating Rooms. Ann Vasc Surg 2018; 50:253-258. [PMID: 29501596 DOI: 10.1016/j.avsg.2017.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/07/2017] [Accepted: 12/17/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND Endovascular procedures come with a potential risk of radiation hazards both to patients and to the vascular staff. Classically, most endovascular interventions took place in regular operating rooms (ORs) using a fluoroscopy C-arm unit controlled by a third party. Hybrid operating rooms (HORs) provide an optimal surgical suit with all the qualities of a fixed C-arm device, while allowing the device to be controlled by the surgical team. The latest studies suggest that an operator-controlled system may reduce the radiation dose. The purpose of the present study is to determine the amount of absorbed radiation using an HOR in comparison with a portable C-arm unit and to assess whether the radioprotection awareness of the surgical team influences the radiation exposure. The primary end point was the effective dose in milliSievert (mSv) for the surgical team and the average dose-area product (ADAP) in Gray-meters squared (Gym2) for patients. METHODS The values of absorbed radiation of the surgical team's dosimeters were collected from January 2015 to May 2016. The HOR was installed in June 2015, and a radioprotection seminar was given in October 2015. The HOR-issued radiation, measured by the maximum dose-area product, ADAP, average dose (AD) per procedure, maximum dose per procedure per month, maximum fluoroscopy time, average fluoroscopic time, peak skin dose, and average skin dose (ASD), was collected monthly from September 2015 to July 2016. The timeline was divided into 3 periods: 5 months pre-HOR (Pre-HOR), 5 months after the HOR installation (PreS-HOR), and 5 months after a radioprotection seminar (PostS-HOR). RESULTS The average number of procedures per month was 22.55 (±4.9), including endovascular aneurysm repair/thoracic endovascular aneurysm repair, carotid, visceral, and upper and lower limb endovascular revascularization. The average amount of absorbed radiation by the surgeons during PreS-HOR was 1.07 ± 0.4 mSv, which was higher than the other periods (Pre-HOR 0.06 ± 0.03 mSv, P = 0.002; PostS-HOR 0.14 ± 0.09 mSv, P = 0.000, respectively). The ADAP during PreS-HOR was 0.016 ± 0.01 Gym2, which was lower than the PostS-HOR (0.001 ± 0.002 Gym2) (P = 0.034). The AD during PreS-HOR was 0.78 ± 0.3 Gy and 0.39 ± 0.3 Gy during PostS-HOR (P = 0.098). The ASD during PreS-HOR was 0.40 ± 0.2 Gy and 0.20 ± 0.1 Gy during PostS-HOR (P = 0.099). CONCLUSIONS In our experience, the HOR increases the amount of absorbed radiation for both patients and surgeons. The radioprotection seminars are of utmost importance to provide a continued training and optimize the use of ionizing radiation while using an HOR. Despite the awareness of the surgical team in the radioprotection field, the amount of absorbed radiation using an HOR is higher than the one using a C-Arm unit.
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Affiliation(s)
- Liliana Fidalgo Domingos
- Department of Angiology and Vascular Surgery, Valladolid University Hospital, Valladolid, Spain.
| | | | | | - Cintia Flota Ruiz
- Department of Angiology and Vascular Surgery, Valladolid University Hospital, Valladolid, Spain
| | | | - Carlos Vaquero Puerta
- Department of Angiology and Vascular Surgery, Valladolid University Hospital, Valladolid, Spain
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Cenizo Revuelta N, Gutiérrez Alonso V, Vaquero Puerta C. Reparación del arco aórtico mediante stent XL en Marfan. Rev Esp Cardiol (Engl Ed) 2017. [DOI: 10.1016/j.recesp.2016.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Del RÍO Solá ML, Vaquero Puerta C. Masson's tumor as a post-catheterization complication. Chirurgia (Bucur) 2017. [DOI: 10.23736/s0394-9508.16.04603-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Brizuela Sanz JA, Estévez Fernández I, Fuente Garrido R, Gutiérrez Castillo D, Vaquero Puerta C. Leiomiosarcoma intraluminal de vena femoral común. Cir Esp 2016; 94:611-613. [DOI: 10.1016/j.ciresp.2016.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 04/18/2016] [Indexed: 11/16/2022]
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Del Río Solá ML, González Fajardo JA, Vaquero Puerta C. [Identifying clinical risk factors in recurrent idiopathic deep venous thrombosis]. Med Clin (Barc) 2016; 146:254-7. [PMID: 26803448 DOI: 10.1016/j.medcli.2015.10.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 10/09/2015] [Accepted: 10/15/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Oral anticoagulant therapy for more than 6 months in patients with an episode of idiopathic thromboembolic disease is controversial. The objective was to determine predictive clinical signs that identify patients at increased risk of thromboembolic recurrence after stopping anticoagulant therapy for 6 months after an episode of idiopathic deep vein thrombosis (DVT). PATIENTS AND METHODS A prospective study which included 306 consecutive patients with a first episode of idiopathic DVT from June 2012 to June 2014. Predictor variables of recurrent thromboembolic disease and episodes of recurrence during follow-up of the patients (28.42 months) were collected. We performed a multivariate analysis to analyze possible predictors (P<.20) and an analysis of Kaplan-Meier to establish mean recurrence-free survival. RESULTS We identified 91 episodes of residual vein thrombosis on follow-up of the patients (37.5% men and 20.3% women) (OR 1.84; 95% CI 1.25-2.71). In the Cox regression analysis stratified by gender, variables showed significant presence of hyperechoic thrombus (P=.001) in males, and persistence of residual thrombus in women (P=.046). The mean recurrence-free survival was shorter in both groups. CONCLUSIONS The presence of echogenic thrombus in men and the existence of residual DVT in women were 2 clinical signs associated with increased risk of thromboembolic recurrence after stopping anticoagulant therapy for 6 months after an episode of idiopathic DVT in our study.
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Affiliation(s)
- M Lourdes Del Río Solá
- Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | | | - Carlos Vaquero Puerta
- Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario de Valladolid, Valladolid, España
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del Río Solá ML, Garrido RF, Alonso VG, Puerta CV. Recanalization of chronic obstruction of common iliac artery in the presence of an ectopic renal artery. J Vasc Surg 2015; 62:1640. [PMID: 26598120 DOI: 10.1016/j.jvs.2014.10.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 10/26/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | - Ruth Fuente Garrido
- Department of Vascular Surgery, University Hospital of Valladolid, Valladolid, Spain
| | | | - Carlos Vaquero Puerta
- Department of Vascular Surgery, University Hospital of Valladolid, Valladolid, Spain
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Domingos LF, Pedrosa MM, Castillo DG, Garrido RF, Puerta CV. [An uncommon cause of lower limb oedema - Case report]. Rev Port Cir Cardiotorac Vasc 2015; 22:231-233. [PMID: 28471141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Indexed: 06/07/2023]
Abstract
Visceral aneurysms, although rare, are potentially life threatening, especially when presented as aneurysm rupture, in which case the mortality rate can rise up to 30-70%. The diagnose of this type of aneurysms has increased in asymptomatic patients due to overspread of radiologic tests. For a long time, the treatment of this type of aneurysm has been the open surgery, nevertheless in recent years the endovascular techniques have risen as an alternative. The two cases described here are two 48 and 71 years-old males, incidentally diagnosed of a celiac artery aneurysm of 15mm and 38mm, respectively, both treated with endovascular techniques. The endovascular treatment has shown to be a safe and effective alternative with less short-term morbi-mortality, than open surgery.
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Affiliation(s)
- Liliana Fidalgo Domingos
- Serviço de Angiologia e Cirurgia Vascular, Hospital Clínico Universitario de Valladolid - Espanha
| | - Miguel Martin Pedrosa
- Serviço de Angiologia e Cirurgia Vascular, Hospital Clínico Universitario de Valladolid - Espanha
| | - Diana Gutiérrez Castillo
- Serviço de Angiologia e Cirurgia Vascular, Hospital Clínico Universitario de Valladolid - Espanha
| | - Ruth Fuente Garrido
- Serviço de Angiologia e Cirurgia Vascular, Hospital Clínico Universitario de Valladolid - Espanha
| | - Carlos Vaquero Puerta
- Serviço de Angiologia e Cirurgia Vascular, Hospital Clínico Universitario de Valladolid - Espanha
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Gutiérrez Castillo D, San Norberto García EM, Fidalgo Domingos L, Fuente Garrido R, Estévez Fernández I, Vaquero Puerta C. [Incidence of contrast induced nephropathy in patients who underwent an aortic endovascular repair]. Rev Port Cir Cardiotorac Vasc 2015; 22:101-107. [PMID: 27927003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Intravascular iodinated contrasts are essencial in endovascular therapy. One of their major inconveniences is contrast-induced nephropathy (CIN), which has been associated with an increase in complications and prolonged hospital stay. AIM To analyze the incidence of CIN in patients undergoing endovascular aneurysm repair (EVAR) in our hospital. MATERIAL AND METHODS A retrospective study including patients (n=129) treated with EVAR between January 2014 - September 2015. Information was gathered concerning age, history of diabetes, hypertension, pre-existing chronic kidney disease and previous treatment with diuretics or metformin. We analyzed serum levels of urea, creatinine, sodium, potassium and glomerular filtrate (GF), at baseline, at 24hours, peak levels during post-operative period and before discharge. The amount of intravascular contrast and periprocedureral hydration were correlated to creatinine and GF to determine their effect on CIN. RESULTS Of 129 patients, 11 (8.53%) developed CIN. A significant difference was found between preoperative and postoperative levels of urea and sodium, both p<0.001.Volume of contrast was the only variable that presented a statistically significant association with increase of creatinine levels in postoperative period (p=0.032). Worsening of glomerular filtrate showed a statistically significant association with preoperative levels of urea (p=0.036) and GF (p= 0.019). Fluid-therapy before or after exposure to contrast did not show any influence on the outcome. CONCLUSIONS The incidence of CIN depends mainly on baseline GF and amount of contrast, and it is barely associated with hydration during the perioperative period. Since there is no specific treatment for CIN, the best practice is its prevention.
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Affiliation(s)
- Diana Gutiérrez Castillo
- Serviço de Angiologia e Cirurgia Vascular, Hospital Clínico Universitário de Valladolid, Espanha
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Fuente Garrido R, Brizuela Sanz JA, Sanchez Santiago AF, Gutiérrez Castillo D, San Norberto García EM, Vaquero Puerta C. Aneurysmal degeneration of brachial artery in kidney transplant receptors after arteriovenous fistula ligation. Rev Port Cir Cardiotorac Vasc 2015; 22:109-113. [PMID: 27927004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Indexed: 06/06/2023]
Abstract
OBJECTIVES True brachial artery aneurysms are. Recent case reports have suggested aneurysmal degeneration of brachial artery in kidney transplant receptors after arteriovenous fistula (AVF) ligation. We present a study on the evolution of the brachial artery in this context in our center. MATERIAL AND METHODS This is a descriptive study in kidney transplant receptors in whom AVF was ligated between 2008 and 2015. Patients with AVF in both upper limbs were excluded. Diameters of axillary artery, brachial artery in middle portion and its bifurcation, as well as brachial artery flow were measured using Dupplex ultrasound in AVF and contralateral limb. Both groups were compared using the Student t-test for paired samples. RESULTS 20 patients were included in the study and had a mean age of 59.35 ± 2.49 years. The median time of use of AVF for hemodialysis was 729 days (range 120-6117) and the median time in which AVF was patent was 2261 days (range 791-7091). Mean diameters (in mm) of axillary artery, brachial in middle portion and bifurcation were respectively 9.33 ± 1.07, 7.5 ± 0.61 and 5.81 ± 0.43 in AVF arm and 5.6 ± 2.8, 4.4 ± 0.1, 4.9 ± 0.15 in control limb, finding statistically significant differences (p <0.01) in brachial and axillary arteries. 5 patients (25%) developed aneurysm, 2 of which (10%) underwent surgery and 3 are on follow up. CONCLUSION True incidence of brachial artery aneurysm in kidney receptors following AVF ligation is high. Careful follow up with physical examination and dupplex scanning are needed to find this complication.
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Affiliation(s)
- Ruth Fuente Garrido
- Departamento de Cirurgia Vascular do Hospital Universitário de Valladolid, Espanha
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del Río Solá ML, Fuente Garrido R, Gutiérrez Alonso V, Vaquero Puerta C. Endovascular treatment of superior vena cava syndrome caused by malignant disease. J Vasc Surg 2014; 59:1705-6. [PMID: 24836767 DOI: 10.1016/j.jvs.2013.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 08/14/2013] [Accepted: 08/14/2013] [Indexed: 11/16/2022]
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Brizuela Sanz J, Taylor J, Cenizo Revuelta N, Ibáñez Maraña M, Gutiérrez Alonso V, Vaquero Puerta C. Endovascular approach in a secondary arterio-ureteral fistula. VASA 2013; 42:68-71. [PMID: 23385228 DOI: 10.1024/0301-1526/a000237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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del Río Solá ML, Antonio J, Fajardo G, Vaquero Puerta C. Influence of Aspirin Therapy in the Ulcer Associated With Chronic Venous Insufficiency. Ann Vasc Surg 2012; 26:620-9. [DOI: 10.1016/j.avsg.2011.02.051] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 01/18/2011] [Accepted: 02/07/2011] [Indexed: 11/26/2022]
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Brizuela Sanz JA, González Fajardo JA, Calavia AR, Díaz BM, Arce N, Baptista ACV, Vaquero Puerta C. [Ecodoppler evaluation on the progress of atherosclerotic disease in patients undergoing contralateral carotid endarterectomy]. Rev Port Cir Cardiotorac Vasc 2011; 18:99-104. [PMID: 23560269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Indexed: 06/02/2023]
Abstract
PURPOSE The clinical utility of monitoring by Doppler ultrasound patients undergoing carotid endarterectomy is not clearly established. Our goal is to evaluate by echo-Doppler the progress of contralateral stenosis in a real environment, in order to assess its usefulness. MATERIAL AND METHODS Retrospective study with Doppler ultrasound monitoring in patients undergoing carotid endarterectomy for a period of 3 years. We included cases with Doppler echography before and at least one post-surgery. We excluded patients with contralateral thrombosis, contralateral stenosis, established surgical indication or prior carotid surgery. Analysis was performed using Kaplan-Meier curves to estimate the rate of patients free of progression and / or surgery, as well as an analysis of risk factors for progression of contralateral stenosis. RESULTS We included 119 patients (41.2% symptomatic) age 68.3 +/- 8.41 years. The follow-up was 40.5 +/- 23.2 months, with a mean of 2.64 +/- 1.58 scans per patient. The likelihood of progression of contralateral carotid stenosis was estimated at 91, 86, 81 and 79% at one, two, three and four years respectively. The only significant risk factor for progression was the presence of moderate or greater contralateral stenosis (30% or more) at the time of surgery. CONCLUSIONS The evolution of the contralateral carotid atherosclerosis is relatively common. The degree of stenosis correlates with early progression, the study by echo-Doppler plays an important role in monitoring these patients.
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García-Gimeno M, Rodríguez-Camarero S, Tagarro-Villalba S, Ramalle-Gomara E, González-González E, Arranz MAG, García DL, Puerta CV. Duplex mapping of 2036 primary varicose veins. J Vasc Surg 2009; 49:681-9. [DOI: 10.1016/j.jvs.2008.09.062] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 09/26/2008] [Accepted: 09/29/2008] [Indexed: 10/21/2022]
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Puerta CV. La investigación en angiologia y cirugía vascular en España. Angiología 2004. [DOI: 10.1016/s0003-3170(04)74842-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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