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1.
J Vasc Access ; 21(1): 55-59, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31188045

RESUMO

OBJECTIVE: The aim of this study was to compare two complex vascular access techniques that utilize the axillary artery as inflow and accesses were created with early cannulation grafts: the axillary-atrial arteriovenous graft versus axillary-iliac arteriovenous graft. METHODS: This is a retrospective study of end-stage renal disease patients with occluded intrathoracic central veins that underwent complex hemodialysis access creation in our institution after failed endovascular recanalization attempts. Patients' demographics, comorbidities, number and types of previous accesses, intraoperative variables, and clinical outcomes were collected and compared. RESULTS: Four patients underwent axillary-atrial arteriovenous graft creation with Flixene™ (Atrium™, Hudson, NH, USA) grafts, through a midline sternotomy to expose the right atrium; all were successfully implanted and used for hemodialysis within the first 72 h; one patient developed a pseudoaneurysm in the mid-graft portion, requiring surgical repair, and it is currently functional. Eight axillary-iliac arteriovenous grafts were created; all grafts were patent and were utilized within 96 h after placement. At 6 months of follow-up period, five (62 %) of our patients underwent graft thrombectomy, one (12 %) balloon angioplasty at the vein anastomosis secondary to stenosis, and two (25 %) grafts were removed due to infectious complications. Axillary-atrial arteriovenous graft and axillary-iliac arteriovenous graft primary patency rates at 6 months were 75% and 48%, respectively; 6-month secondary patency of the axillary-atrial arteriovenous graft compares favorably against that of axillary-iliac arteriovenous graft (100% vs 75%, respectively). CONCLUSION: Despite the invasiveness, direct atrial outflow procedures remain a valid alternative in carefully selected patients with adequate cardiopulmonary reserve.

2.
Ann Vasc Surg ; 62: 57-62, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31201975

RESUMO

BACKGROUND: The pathogenesis of atherosclerotic abdominal aortic aneurysms (AAAs) remains not fully understood. Histological analyses confirm chronic adventitial and medial inflammatory cell infiltration, and its pathophysiology involves the upregulation of proteolytic pathways; added to this, genetic factors have been suggested to favor the susceptibility for AAA. The aim of the present study was to analyze the association between genetic polymorphism of the class II human leukocyte antigens (HLAs, HLA-DRB1) with the susceptibility to develop AAA in Mexican patients and to initiate a pilot study of single-nucleotide polymorphisms (SNPs) rs1024611 in the monocyte chemoattractant protein-1 (MCP-1/CCL2) gene to investigate a possible role in the AAA pathogenesis. METHODS: In a cohort of patients with AAA, HLA molecular typing was completed for DRB1 loci with LABType SSO-One Lambda kit in 39 patients (69% men with a mean age of 72 years) and compared with 99 without the disease (60% men, mean age 65 years) (control group). Genotyping of rs1024611 in the MCP-1 gene was performed using TaqMan predesigned SNP genotyping assays in 27 patients with AAA (63% men, mean age of 71). Gene frequencies (gfs) and genotype frequencies (Gfs) were determined; categorical data were analyzed by nonparametric statistic test at significance level (P < 0.05), and odds ratios (ORs) were calculated using the STATA v14 software and StatCalc software Epi Info™ 7.2.2.2. RESULTS: Seventy-eight HLA-DRB1 alleles of patients with AAA and 198 from the control group were studied. We observed that the gf of HLA-DRB1*01 was 0.128 in the AAA group compared with 0.05 in the control group (P = 0.03, OR: 2.6, 95% confidence interval [CI]: 1.04-6.5); the gf of HLA-DRB1*16 was 0.115 in the AAA and 0.025 in control group (P = 0.002, OR: 5, 95% CI: 1.6-16.9). The Gf for SNP rs1024611 were 0.51 in the GA genotype, 0.30 in AA, and 0.19 of GG. Four patients with the proinflammatory homozygous genotype GG (80%) were women and younger than patients with other genotypes, and only one had a history of dyslipidemia. CONCLUSIONS: The dissection and interpretation of an immunogenetic profile in patients with AAA is an active and complex field of research that might assist in a more precise identification of those patients at genetic risk. Our study demonstrated increased frequencies of HLA-DRB1*01 and HLA-DRB1*16 alleles in Mexican patients with AAA compared with an ethnically matched control group.

3.
Arch Med Res ; 50(5): 257-258, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31593849

RESUMO

Acute pulmonary embolism remains a catastrophic acute cardiovascular event, and it is the leading cause of preventable mortality among hospitalized patients. Pulmonary embolism response teams have been designed to facilitate efficiency, streamline and improve quality of care in a timely manner for complex pulmonary embolism case scenarios with a multidisciplinary approach. Herein, we briefly describe and delineate the main goals and strategies on how to leverage the strengths from such pulmonary embolism response teams, with the aim to be adopted worldwide, improve survival, and change the paradigm in the care of a potentially deadly disease.

4.
Vasc Specialist Int ; 35(3): 170-173, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31620404

RESUMO

The development of post-catheterization arterial pseudoaneurysms is one of the most common vascular access complications following angiographies and endovascular interventions. Different therapeutic options to treat these lesions have been used. We herein report the case of a 79-year-old woman who was referred to our service for evaluation with a post-catheterization superficial femoral artery pseudoaneurysm measuring 4 cm. Owing to the anatomical location of the arterial pseudoaneurysm and the patient's refusal to undergo open surgery, we treated the lesion using an endovascular approach with a balloon tamponade. The procedure was successful, and the patient recovered well and was discharged from the hospital without complications. At 6-month follow-up she remained symptom-free and without recurrence.

6.
Arch Cardiol Mex ; 89(3): 216-221, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31588130

RESUMO

Objective: Anticoagulation is the primary management to prevent venous thromboembolism; inferior vena cava filters (IVCFs) provide a mechanical prophylactic alternative when anticoagulation is contraindicated. The aim of this study was to evaluate in IVCF patients, whether the initiation of anticoagulation therapy is associated with decreased rates of recurrent thrombotic events and device-related complications. Methods: This was a retrospective review of patients that underwent insertion of IVCF. Subjects with IVCF were studied in two groups: those initiated on anticoagulation (A) and without anticoagulation (NA). Variables as indications for IVCF, anticoagulation, recurrence of thrombosis, complications, and reinterventions were examined. Results: From April 2007 to March 2014, 54 patients underwent IVCF placement; (61% of females), with mean age of 54 years (standard deviation ± 19). 28 (52%) were initiated on anticoagulation, during a mean follow-up period of 28 months, five experienced recurrent thrombosis and three were on the A group (p=0.5); when comparing patients that developed post-thrombotic syndrome, seven were in the A group and seven in the NA. Two patients with IVC rupture were in the A group (p=0.5), and the only case of IVCF migration occurred in the A group. 11 (20%) patients died from comorbidities nonrelated to the device or procedure (four in the A cohort). Conclusions: Patients with IVCF on anticoagulation have equivalent rates of thrombotic events and device-related complications than those patients NA.

9.
Ann Vasc Dis ; 12(2): 243-245, 2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31275484

RESUMO

Retroperitoneal tumors (RTs) are frequently found as large masses upon diagnosis. Within the differential diagnosis of RTs, one of the most important are germ cell tumors. We report here the case of a 30 year old man with a recurrent RT involving the inferior vena cava (IVC). Once discussed, he underwent a tumor resection with a primary IVC reconstruction maintaining vessel patency. On histopathology, a mixed germ cell tumor was reported. The patient recovered well and he was discharged from the hospital without complications.

10.
Cir Cir ; 87(4): 470-476, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31264994

RESUMO

An abdominal aortic aneurysm is defined as a focal dilation greater than 50% of the normal diameter of the vessel. The prevalence in individuals older than 65 years is estimated between the 2 and 8% with a risk of rupture when the diameter >5.5 cm in men and 5 cm in women. The risk increases exponentially with the expansion of this aneurysmal sac, and if the rupture occurs, its mortality can achieve 80%. The pathogenesis and factors associated to the development and progression of this disease remain not fully understood and isolating the aneurysm from the circulation is the main therapeutic goal to eliminate the risk of rupture. Over the last decades, ultrasonographic screening programs have been implemented for its detection. In this article, we review the epidemiology, natural history of aneurysms and the relevance of ultrasonographic screening programs.


Assuntos
Aneurisma da Aorta Abdominal/diagnóstico por imagem , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Aneurisma Roto/etiologia , Aneurisma da Aorta Abdominal/epidemiologia , Aneurisma da Aorta Abdominal/etiologia , Progressão da Doença , Feminino , Humanos , América Latina/epidemiologia , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Sexuais , Ultrassonografia , Reino Unido/epidemiologia
11.
BMC Med Genet ; 20(1): 102, 2019 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174489

RESUMO

BACKGROUND: Multiple factors are implicated in the etiology and pathogenesis of Abdominal Aortic Aneurysms (AAA). Available literature of genetic studies has previously suggested the possible roles of autoimmunity, genetic predisposition and ethnic susceptibility. Due to the association with autoimmune diseases and proven application in population genetics, we aimed to investigate alleles of the Class II Human Leukocyte Antigens (HLA-DRB1) in the Mexican Mestizo population with aortic aneurysms and determine possible associations with susceptibility. METHODS: We performed a case Control Study; the HLA molecular typing was completed for DRB1 loci by LabType Sequence-Specific Oligonucleotide (SSO) SSO-OneLambda kit (Applied Biosystems; Thermo Fisher Scientific. Inc.) in the studied individuals. Allele frequencies (af) were determined, associations were assessed by chi square or fisher exact tests at significance level (< 0.05), and Odds Ratios (OR) were calculated using the STATA software version 14. RESULTS: The genetic polymorphism of HLA-DRB1 of fifty one patients (70% males with a mean age of 71 years) with atherosclerotic or also known as degenerative AAA were compared with 99 unrelated patients (60% males, mean age 65 years) without the disease [Control group (CG)] from the same ethnic group. We examined a total of 102 Class II HLA-DRB1 alleles of AAA patients and 198 from CG. When comparing af, we observed the HLA-DRB1*01 af of 0.139 in the AAA compared to 0.05 in the CG [p = 0.015, OR 3, 95% confidence interval (CI) 1.29-7.08], the HLA-DRB1*16 af were 0.109 in the AAA and 0.025 in CG (p = 0.006, OR 4.7, 95% CI 1.59-13.98). CONCLUSIONS: Our study confirmed increased frequencies of the alleles HLA-DRB1*01 and HLA-DRB1*16 and their association to the development of AAA in Mexican Mestizo patients. The utility of genetic testing may assist in identifying individuals at genetic risk for the development of this disease in different ethnic groups, who might benefit from earlier ultrasound screening and closer imaging surveillance.


Assuntos
Aneurisma da Aorta Abdominal/genética , Grupos Étnicos/genética , Predisposição Genética para Doença/genética , Cadeias HLA-DRB1/genética , Polimorfismo Genético , Idoso , Alelos , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/etnologia , Estudos de Casos e Controles , Feminino , Frequência do Gene , Predisposição Genética para Doença/etnologia , Humanos , Masculino , México , Pessoa de Meia-Idade
13.
Gac Med Mex ; 155(2): 136-142, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31056599

RESUMO

Introduction: In Mexico, there are no appropriate statistical data on aortic disease, which can be treated with medical management or open or endovascular surgical approach. Objective: To carry out a systematic search and review of the literature in electronic databases with regard to invasive management of aortic pathology in Mexico. Method: A systematic search and narrative review of available literature was carried out using different electronic databases: PubMed, Imbiomed, Clinical Key, Bibliat, Scielo, Sage Journals and Sciencedirect, as well as with the Google Scholar search engine. Results: Ninety articles were found, out of which only 53 met the inclusion criteria. Observational studies and case reports were selected, emphasizing on patient demographics, clinical results, and 30-day postoperative survival. Conclusion: An elevated rate of complications is reported for aortic pathologies due to underdiagnosis, which results in management being more complicated and prognosis unfavorable. The creation of a national aortic disease registry is crucial to standardization in the approach and optimization of results.


Assuntos
Doenças da Aorta/cirurgia , Procedimentos Endovasculares/métodos , Complicações Pós-Operatórias/epidemiologia , Doenças da Aorta/diagnóstico , Humanos , México , Prognóstico , Taxa de Sobrevida
17.
Cir Cir ; 87(2): 170-175, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30768059

RESUMO

Background: To analyze the factors that influence the deterioration of postoperative renal function in patients undergoing open or endovascular aortic reconstruction, and the impact on survival. Method: Retrospective review of patients who underwent invasive treatment was conducted. Demographics, laboratory data, clinical, intraoperative and postoperative variables were recorded; renal function was determined, Fisher's exact test was used to find associations and Kaplan Meier analysis to estimate survival. Results: From 2007 to 2017, 80 patients (mean age: 70 years) were studied. Fifty-eight (73%) were male, none of these patients had known diagnosis of chronic kidney insufficiency. Twelve (15%) patients had elevated creatinine in the postoperative period; variables such as intraoperative bleeding greater than 1500 ml were associated with acute renal failure (p = 0.005). During the follow-up period of 60 months, 8 (10%) patients progressed to chronic renal failure, 2 (2.5%) requiring hemodialysis, 18 (22%). Age, gender, comorbidities and anatomic characteristics of the aneurysm, type of intervention or level of aortic cross-clamping did not impact the postoperative renal function. Conclusions: The repair of complex aortic aneurysms continues to be a challenge. Intraoperative bleeding greater than 1500 ml and the need of blood transfusion was associated with deterioration of postoperative renal function, affecting the 5-year survival of patients.


Assuntos
Lesão Renal Aguda/etiologia , Aneurisma Aórtico/cirurgia , Procedimentos Endovasculares/efeitos adversos , Falência Renal Crônica/etiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Lesão Renal Aguda/sangue , Lesão Renal Aguda/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Aórtico/mortalidade , Perda Sanguínea Cirúrgica , Creatinina/sangue , Procedimentos Endovasculares/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/sangue , Falência Renal Crônica/mortalidade , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/mortalidade , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Diálise Renal/estatística & dados numéricos , Estudos Retrospectivos , Adulto Jovem
18.
J Hand Surg Asian Pac Vol ; 24(1): 89-92, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30760156

RESUMO

Parkes Weber Syndrome (PWS) is a congenital disorder characterized by the presence of arteriovenous malformations (AVMs) in upper or lower extremities. We herein present a 35 year-old male with PWS with complex AVMs in the right upper extremity; he had been previously treated with multiple sessions of vessel embolization, sclerotherapy and AVM resections. The patient presented to our clinic with two month history of progressive hand ischemia, digit necrosis and infection. Angiography was performed demonstrating numerous AVMs and filiform flow through the ulnar artery with poor opacification of arterial structures in the hand. Because of advanced ischemia, soft tissue infection and osteomyelitis, a distal forearm amputation was indicated. Hand threatening ischemia secondary to steal phenomenon associated to AVMs in PWS is rarely encountered and reported. This case illustrates a complex clinical presentation with advanced disease that required limb amputation.


Assuntos
Malformações Arteriovenosas/diagnóstico por imagem , Mãos/irrigação sanguínea , Isquemia/etiologia , Síndrome de Sturge-Weber/complicações , Síndrome do Roubo Subclávio/diagnóstico por imagem , Adulto , Amputação , Angiografia por Tomografia Computadorizada , Mãos/cirurgia , Humanos , Isquemia/cirurgia , Masculino , Osteomielite/complicações , Infecções dos Tecidos Moles/complicações , Artéria Ulnar/diagnóstico por imagem
19.
Ann Vasc Surg ; 57: 187-193, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30684613

RESUMO

BACKGROUND: Carotid body tumors (CBTs) are rare neoplasms located in the carotid bifurcation. The majority of these tumors are unilateral; bilateral CBTs represent approximately 5% of all affected patients, and the recommended treatment is to surgically remove them in staged-planned surgeries. We describe the experience, outcomes, and the surgical management of bilateral CBTs in our institution. METHODS: A retrospective review of CBTs patients was completed; patient demographics, comorbidities, lesion location, anatomic characteristics, surgical techniques, complications, reinterventions, and other factors that may influence outcomes were evaluated. RESULTS: A total of 109 patients with CBTs were treated surgically; of these, 8 had bilateral CBTs (7%); the mean age was 56 years, and 7 (87%) were females. Thirteen surgical resections were performed, and in 2 of the cases, the pathology report was malignant (15%). Five were classified as Shamblin I (31%), 5 as Shamblin II (31%), and remaining 6 as Shamblin III (38%). The mean time between the first and second procedure was of 10.7 months. Complications included one case of neck hematoma requiring evacuation and postoperative neurologic complications occurred in three patients (one patient with facial and two with vocal cord palsies). None of the studied individuals had a family history of CBT, and all of them lived in altitude areas higher than 2000 meters above mean sea level (mamsl). The mean tumor size was 3.55 cm and 2.75 cm for right and left CBTs, respectively. CONCLUSIONS: A better understanding of the clinical characteristics of patients with bilateral CBTs may lead to a more standardized and optimal management with fewer complications and a better quality of life afterward.


Assuntos
Tumor do Corpo Carotídeo/cirurgia , Procedimentos Cirúrgicos Vasculares , Adulto , Idoso , Tumor do Corpo Carotídeo/diagnóstico por imagem , Tumor do Corpo Carotídeo/epidemiologia , Tumor do Corpo Carotídeo/patologia , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Carga Tumoral , Procedimentos Cirúrgicos Vasculares/efeitos adversos
20.
Arch Cardiol Mex ; 89(3): 196-201, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31967587

RESUMO

Objective: Anticoagulation is the primary management to prevent venous thromboembolism; inferior vena cava filters (IVCFs) provide a mechanical prophylactic alternative when anticoagulation is contraindicated. The aim of this study was to evaluate in IVCF patients, whether the initiation of anticoagulation therapy is associated with decreased rates of recurrent thrombotic events and device-related complications. Methods: This was a retrospective review of patients that underwent insertion of IVCF. Subjects with IVCF were studied in two groups: those initiated on anticoagulation (A) and without anticoagulation (NA). Variables as indications for IVCF, anticoagulation, recurrence of thrombosis, complications, and reinterventions were examined. Results: From April 2007 to March 2014, 54 patients underwent IVCF placement; (61% of females), with mean age of 54 years (standard deviation ± 19). 28 (52%) were initiated on anticoagulation, during a mean follow-up period of 28 months, five experienced recurrent thrombosis and three were on the A group (p=0.5); when comparing patients that developed post-thrombotic syndrome, seven were in the A group and seven in the NA. Two patients with IVC rupture were in the A group (p=0.5), and the only case of IVCF migration occurred in the A group. 11 (20%) patients died from comorbidities nonrelated to the device or procedure (four in the A cohort). Conclusions: Patients with IVCF on anticoagulation have equivalent rates of thrombotic events and device-related complications than those patients NA.

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