I. Martínez López

Hospital Clínico San Carlos, Madrid, Madrid, Spain

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Publications (15)7.15 Total impact

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    ABSTRACT: Purpose : To report midterm outcomes for endovascular treatment of external iliac artery (EIA) occlusive disease and assess possible factors affecting patency. Methods : A retrospective analysis was conducted of 99 consecutive patients (91 men; mean age 67.3 years) with claudication (n=70) or critical limb ischemia (n=29) owing to occlusive EIA disease treated at our center from January 2005 to June 2012. The majority of lesions (79/108) were TASC A/B. Lesions were a mean 42.2 mm long (range 10-125); 43/108 affected the distal third of the EIA. Balloon angioplasty alone was performed in 7 limbs, while the remaining 101 lesions were stented (65 self-expanding, 24 balloon-expandable, and 12 covered). Clinical and hemodynamic follow-up was performed at 1, 3, 6, and 12 months after therapy and yearly thereafter. The factors examined were procedure characteristics and patency rates. Results : Over a median follow-up of 27.5 months (range 1-89), there were 2 (1.9%) early occlusions followed by a successful reintervention, 4 late occlusions, and 5 hemodynamic failures followed by 7 reinterventions. These events led to primary and secondary patency rates at 30 months of 89.7% and 94.1%, respectively. No differences in patency rates were detected according to age, clinical state, or comorbidity. Use of covered stents (p=0.006) was the only variable associated with lower primary patency rates. Conclusion : Endovascular therapy to treat TASC A/B lesions of the EIA yielded good short and midterm patency and low early morbidity and mortality. Lesions involving the distal third of the EIA treated by simple angioplasty ± stenting fared worse. No clinical factors could be correlated with patency.
    Journal of Endovascular Therapy 04/2014; 21(2):223-9. · 2.70 Impact Factor
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    ABSTRACT: Background Type II endoleaks (ELII) may increase the complication rate. An evaluation was made of the association between thrombus load and development of ELII, and aneurysm sac growth. Material and methodmethods A total of 103 endovascular aortic repair patients were analyzed. The maximum thrombus thickness (GMT), percentages of area (PAOT) and perimeter lined by thrombus (PPCT), and posterior thickness (GMHP) were determined from pre-operative CT at 3 levels: zone A (maximum diameter), zone B (from zone A to bifurcation), and zone C (from neck to zone A). The number of aortic side branches was recorded, and sac diameter was measured during follow-up. Results A total of 51 endoleaks (49.5%) were noted. Patients with ELII had significantly less GMT (24.0 vs. 18.6 mm, P=.01) and GMHP (13.9 vs. 18.9 mm, P=.003) in zone A, and PAOT (49.7 vs. 65.4%, P<.001), PPCT (72.4 vs. 82.3%, P<.001), and PTHP (63.7 vs. 74.7%, P=.03). The average number of side branches was 5 in patients without ELII versus 6 with (P=.004). Lower risk of ELII was observed with: PAOT (OR = 0.65 for a 10% increase, 0.44-0.98, P=.03), PPCT in zone B (OR = 0.69 for each 10% increase, 0.50-0.95, P=.01), and C (OR = 0.68, 0.52-0.88, P=.002), GMHP in zone A (OR = 0.71 for each 5 mm increase, 0.49-0.99, P=.04), and PTHP in zone B (OR = 0.81 for 10% increase, 0.67-0.99, P=.02). The patent IMA (OR = 3.1, 1.1-8.9, P=.033), the number of patent branches (OR = 4.6 with more than 4 branches, 1.8-12.2, P = 0.024), and lumbar branches (OR = 1.9 for each patent lumbar, 1.1-3.5, P=.017) were associated with an increased risk of ELII. The greater PAOT, PPCT, GMHP, and PTHP were, the higher regression/stability of the sac was. Conclusions Quantification of the thrombus load and the number of patent side branches can be used to determine patients at increased risk of ELII and sac growth during follow-up.
    Angiología 01/2014;
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    ABSTRACT: Cystic adventitial disease (CAD) is a rare, non-atherosclerotic vascular condition predominantly seen in middle-aged men with no cardiovascular risk factors. Three cases have been diagnosed and treated in our institution during the past eight years. The purpose of this report is to provide an updated literature review of this condition with the addition of three new cases. Information about three new cases is presented as well as data obtained from articles published between 1979 and 2012 from Pubmed and Embase databases. 238 articles were found and 98 finally included in our review. All of patients treated presented with rapidly progressive intermittent calf claudication. Diagnosis of CAD was confirmed by at least two imaging techniques, either duplex ultrasound or MRI, with a preoperative angiography performed in all cases. Wall cyst resection was performed in the three cases reported, after intraoperatively confirmation of no arterial wall damage. All of the patients remained asymptomatic with no signs of recurrence after a median 36-month follow-up (24-60 month follow-up). CAD is a rare vascular condition usually affecting arteries and presents as a sudden onset of unilateral intermittent calf claudication. Diagnosis must be confirmed with imaging techniques, such as Duplex ultrasonography and MRI. Based in the existing knowledge, treatment of choice remains surgical, with cystic evacuation in cases of no arterial wall damage or resection and grafting. However, follow-up algorithm of treated patients remains unclear.
    Annals of Vascular Surgery 12/2013; · 0.99 Impact Factor
  • Revista Clínica Española 03/2013; · 2.01 Impact Factor
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    ABSTRACT: Aim: Traumatic aortic injury is usually lethal, most often because of serious associated wounds. The short- and midterm outcome of endovascular exclusion was assessed as the current treatment of choice due to a lower mortality and morbidity than open surgical treatment. Methods:We reviewed the cases of 8 patients (5 male, mean age 33 years) undergoing endovascular repair of a traumatic thoracic aortic lesion, confirmed by computed tomographic angiography, at our centre. Most patients showed a contained lesion limited to the aortic isthmus and severe associated injuries. Results: Intrahospital mortality was 37.5% (N.=3) and mostly due to posttraumatic brain injury (N.=2). Most patients were hemodynamically stable at the time of endovascular repair (N.=6). The median time to surgery was 12 hours (3-48 hours). The endografts used were TAG® (W.L. Gore and Associates, Flagstaff) in three patients, and Valiant® (Medtronic, Santa Rosa, CA) in four. The technical success rate was 100%. In one case, the left subclavian artery was occluded without signs of arm ischemia. There were no cases of paraplegia or stroke related to treatment. No revision procedures were needed during follow-up. Conclusion: Endovascular repair shortly after injury seems to be effective and safe with a low associated morbidity and mortality.
    International angiology: a journal of the International Union of Angiology 02/2013; 32(1):61-6. · 1.46 Impact Factor
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    ABSTRACT: Objective To analyse the effects of suprarenal cross-clamping (SC) as opposed to the infrarenal position (IC) in the evolution of the renal function abdominal aorta aneurysm (AAA) surgery. Material and method A retrospective cohort study of AAAs treated by elective open surgery between 1998 and 2011. The preoperative level of serum creatinine (mg/dL) was determined and compared to postoperative level at 24, 48, 72 and 96 hours, and on discharge. A deterioration in the renal function was defined as a creatinine > 2 mg/dL in patients with a normal baseline creatinine level or an increase of double the baseline creatinine in patients with a previous chronic renal insufficiency (CRI). A deterioration of the glomerular filtrate (GF) was defined as a > 25% decrease. Multivariable analysis was performed on the evolution of the renal function. Results A total of 464 AAA's were analysed, 359 (77.4%) with IC, and 105 (22.6%) with SC. The prevalence of preoperative CRI was similar in both groups. The type of clamp was not associated with a deterioration in the renal function (SC = 8.6% vs. IC = 5.7%; p = .13) but was associated with a deterioration of the GF (SC = 27.6% vs. IC = 13.4%; p = .001). The time the clamp was in place, the blood loss, and the preoperative CRI were independent risk factors for the deterioration of the renal function. The type of clamp increased the risk of deterioration of the renal function beyond 30 minutes (p = .001), being independently associated with a deterioration in the GF (OR 2.04; 95% CI: 0.94-4.47). Conclusion With SC less than 30 min, in patients with a creatinine level, a deterioration in the renal function is not foreseeable. With prior CRI, or if a prolonged SC is foreseen, a deterioration in the renal function can be expected, thereby making it necessary to evaluate methods for renal protection.
    Angiología 01/2013; 65(6):211–217.
  • Angiología 01/2012; 64(6):250–252.
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    ABSTRACT: Introduction and objectives: To establish both the prevalence of carotid stenosis-occlusion in patients with lower limb intermittent claudication referred to our Department between May 2007 and February 2008, and the risk factors of carotid disease. Patients and methods: Cross-sectional design. Exclusion criteria: patients with previous neurological symptoms and patients with previous carotid echographic Doppler (Echo-SAT). We recorded cardiovascular risk factors, personal history of ischaemic heart disease and the presence of carotid bruit. We also performed an ankle-brachial index (ABI) and a carotid echo-Doppler. Results: We analysed 173 patients, 89.6% of whom were male, with a mean age of 68.1 years and 19.7% of carotid bruit. The prevalence of >30 and >50% carotid stenosis was 15% and 9.8%, respectively, and the mean ABI was 0.68. We observed a statistically significant association between the presence of a carotid bruit and that of any degree of carotid stenosis (OR = 6; P=.0001), or the diagnosis of >50% stenosis (OR = 5.9; P=.0001). There were also significant differences in the ABI values of patients with carotid stenosis compared to patients without it (0.58 vs 0.69, P=.05). The patients with an ABI less than 0.7 had a higher prevalence of severe stenosis-occlusion than the patients with a higher ABI (10.6% vs 1.4%, P=.029). Conclusions: The presence of asymptomatic carotid stenosis is not uncommon in patients with peripheral artery disease. In our study, the presence of a carotid bruit and an ABI <0.7 have shown to be markers of carotid disease.
    Angiología 01/2011; 63(5):187-192.
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    ABSTRACT: IntroductionAdvances in endovascular therapy have provided new options for treatment of femoropopliteal disease.Objective To evaluate the safety and efficacy of Viabahn® for the treatment of femoral-popliteal artery disease.Materials and methodsFrom 2005 until 2010, a Viabahn® endoprosthesis was implanted in 30 limbs of 30 patients to treat superficial femoral artery and above-knee occlusive lesions. Follow-up evaluation with ankle-brachial indices and colour flow duplex imaging were performed at 1, 3, 6, 12 months, and then, each year.ResultsA total of 30 patients were treated, with a mean age of 69 years (range 45-82), including 87% (26) male, 57% (17) diabetic, 73% (22) hypertensive, and 87% (26) current or former smokers. Patients had chronic limb ischemia in Fontaine stages IIb 13.3%, III (46.7%), and IV (40%). The treated lesions were TASC II A 16.7% (5), B 60% (18) and C 23.3% (7). There were 25 chronic occlusions (83.3%) and 5 stenoses (16.7%). The average length of treated lesions was 69 mm (range 20-150 mm). In 2 cases, major complications (1 early thrombosis and 1 thromboembolism) required additional surgery. The mean follow-up was 16 months. The primary patency rates were 74.7%, 65.4%, and 56% at 6, 12 and 24 months. Four restenoses were successfully treated. The assisted primary patency rates were 80.7%, 75.3%, and 64.6% at 6, 12 and 24 months. Late thrombosis was observed in 7 cases (23.3%). The secondary patency rates were 84.2%, 78.9%, and 69% at 6, 12, and 24 months.Conclusions Management of femoro-popliteal arterial occlusive lesions with stent-grafts has acceptable clinical results in selected patients. However, strict monitoring is needed, and a high number of reoperations are expected to ensure proper patency.
    Angiología 01/2011; 63(4):151–156.
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    ABSTRACT: IntroductionTissue ischaemia is the end result of a process involving a large number of molecules that mediate the endothelium-vascular smooth muscle interaction, among which is found endothelin-1 (ET-1), a molecule synthesized by the vascular endothelium and induces vasoconstriction, is proinflammatory, and has mitogenic action.
    American Journal of Human Genetics - AMER J HUM GENET. 01/2011; 63(1):7-10.
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    ABSTRACT: Background Autogenous arteriovenous fistula (AVF) are the best vascular access for haemodialysis due to its durability and low complication rates.
    American Journal of Human Genetics - AMER J HUM GENET. 01/2010; 62(3):97-102.
  • Angiología 01/2010; 62(2):78–80.
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    ABSTRACT: IntroductionAdvances in endovascular techniques have provided new options in the treatment of complex infrainguinal occlusive lesions.AimsTo evaluate the effectiveness and patency of endovascular treatment in patients with femoropopliteal occlusive disease.Methods All patients undergoing endovascular interventions for superficial femoral artery and above knee popliteal artery obstructions between February 1997 and February 2009 were retrospectively reviewed and assessed for comorbidities, operative and follow-up variables potentially associated with restenoses and limb salvage.ResultsDuring the study period, 52 patients were treated. Patients were 71.7 years (range 40 to 94), 69.2% male, 53.8% diabetic, 69.2% current or former smokers, and 67.3% hypertensive. Lesions were 28.8% TASC II C, 46.2% TASC II B, and 25% TASC II A. Mean recanalization length was 73.6 mm (range 20 to 150 mm). There were three embolizations, and four early thrombosis. Mean follow-up time was 18 months (range 1 to 115), based on clinical, hemodynamic, and ultrasound data. Primary patency rates were 85%, 76.8%, 60% and 52.5% at 3, 6, 12 and 24 months. Ten restenoses were successfully treated. The assisted primary patency rates were 85%, 82.3%, 74% and 74% at 3, 6, 12 and 24 months. Eight complete occlusions could not be reverted by a second recanalization procedure, and were treated by surgical bypass (6 cases) and amputation (2 cases). The secondary patency rates were 91.4%, 86%, 76.4% and 76.4% at 3, 6, 12, and 24 months.Conclusions Endovascular recanalization is a viable and effective strategy for lower limb revascularization in selected patients.
    Angiología 01/2010; 62(4):133–139.
  • Fascículos de Avances en Cirugía Vascular. 01/2009;
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    ABSTRACT: Objectives To show the results of selective surgical treatment of inflammatory abdominal aortic aneurysms (IAAA), and to analyse the evolution of periaortic inflammation (PAI) and acute phase reactants (APR) after surgery.Patients and methodA retrospective analysis was made of the IAAA electively operated on between 1990 and 2010 by means of open surgery. The median follow-up period was 71 months and an analysis was made of the PAI and APR after surgery.ResultsA total 38 patients underwent treatment, of which 12 (31.5%) were symptomatic. Hydronephrosis was evident in 7 cases (18.4%). The implantation of a pre-operative double-J catheter was necessary in 5 cases (13.1%). One patient (2.6%) died in the immediate post-operative period, and 3 were re-operated on due to bleeding (7.8%). During the follow-up period the hydronephrosis improved in 5 patients (71%), with a survival rate at 12, 36 and 72 months of 92%, 85% and 81%, respectively.With regard to the APR, a significant reduction was produced both in the erythrocyte sedimentation rate (ESR) (P=.01) and in the C-reactive protein (CRP) (P=.01) after surgery. Likewise, the PAI was significantly reduced during the follow-up period, mainly from the ninth month following the surgery (P=.02).Conclusions Selective surgery of IAAA offers good results in the short and long term, associated with a decrease in the APR and PAI, the latter mainly from the ninth month of the post-operative period.
    Angiología 64(5):206–211.