I. Martínez López

Hospital Clínico San Carlos, Madrid, Madrid, Spain

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Publications (21)7.15 Total impact

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    ABSTRACT: To assess the enlargement of ectatic common iliac arteries (CIA) which are not covered during endovascular aortic aneurysm repair (EVAR) due to the existence of more favorable proximal sealing zones.Material and methodsPatients who underwent elective EVAR, with a 5 year follow up were included in a retrospective cohort study. Only cases with distal sealing zones in CIA were studied, recording a maximum basal diameter at the non-covered segment of CIA, and at 1, 2, 3, 4 and 5 years. Cases with distal sealing on external iliac artery were excluded. The sample was analyzed according to:A)CIA baseline diameter: group 1 (G1) (n = 67): < 16 mm; group 2 (G2) (n = 23): ≥16 mm.B)Sealing zone: proximal two thirds of CIA (n = 40); distal third (n = 50).ResultsA total of 56 patients were included in the study, with 90 CIA analyzed.A)Mean diameters in G1 and G2 (baseline, 3, 5 years) were: 12.8, 13.1, 13.3 versus 18.0, 19.4, 20.3 mm, respectively, with a 1.8 mm greater enlargement for G2 (P<.001) at 5 years. No type IB endoleaks were registered during follow up.B)A significant interaction was observed (P=.01) between the distal sealing zone and basal diameter for iliac enlargement: in CIA ≥16 mm distal sealing in the distal third of the CIA was protective for iliac enlargement (P=.04).Conclusions Iliac enlargement in non-treated segments of CIA after EVAR is greater in ectatic arteries. In these cases, distal sealing on the distal third of the CIA can decrease enlargement rate. However, if a more favorable zone for sealing exists proximally, the enlargement of the ectatic CIA does not result in a higher rate of complications.
    Angiología 11/2014;
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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 09/2014;
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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: Objectives To assess the outcomes of prosthetic bypass grafts in critical limb ischemia, as well as to determine the predictors of patency and limb salvage. Materials and methods Retrospective cohort study of patients with critical limb ischemia undergoing a prosthetic infrainguinal bypass graft between 1997 and 2013 in a single centre. The pre- and post-operative data were collected, and the cohort was divided into 3 groups according to the location of the distal anastomosis: Above-knee popliteal artery (POP1), below-knee popliteal artery (POP3), or femorodistal. An assessment was made of the primary patency, assisted primary patency, secondary patency, limb salvage, and survival. Stratified statistical analysis using the Kaplan-Meier for patency, limb salvage and survival. Univariate and multivariate analysis of risk factors associated with the results using Cox regression. Results A total of 154 prosthetic graft bypass, divided into POP1 36.4% (n = 56), POP3 50% (n = 77), and femorodistal 13.6% (n = 21). Differences were found in mean age (POP1 68.9 years, POP3 77.2 years, femorodistal 76.8 years; P < .001). Median follow-up was 11 months. The best outcomes were found in POP1, and the worse in femorodistal in terms of patency and limb salvage (Log Rank P1 0.004, P1A 0.001, P2 0.001 and SE 0.025), with no differences in survival time (Log Rank 0.068). Coronary artery disease and femorodistal bypass were independent risk factors in patency and limb salvage. Older patients and those with chronic renal failure had higher mortality rates. Conclusions Prosthetic infrainguinal bypass graft has fairly good outcomes in critical limb ischemia. The worst outcomes may be expected in patients with coronary artery disease and femorodistal bypass.
    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
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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 11/2013; 65(6):211–217.
  • 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
  • Angiología 11/2012; 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.
    Angiología 01/2011; 63(1):7-10.
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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 07/2010; 62(4):133–139.
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    ABSTRACT: Introducción y objetivos: Varios estudios sugieren que la endarterectomía carotídea (EDAC) puede aportar menos beneficios en mujeres que en hombres debido a la mayor incidencia de complicaciones y tasa de reestenosis. El objetivo de este trabajo es determinar si el sexo femenino es un factor de mal pronóstico de la EDAC. Pacientes y métodos: 760 EDAC consecutivas (1987-2009).Estudio retrospectivo. Mujeres: 131(17,3%). Análisis comparativo entre sexos: datos demográficos, comorbilidad, técnicas quirúrgicas, complicaciones perioperatorias. Reestenosis en el seguimiento, supervivencia y supervivencia libre de ictus. Método estadístico: Chi-cuadrado, t de student, Kaplan-Meier. Resultados: Edad media: 68,6 (mujeres-hombres: 70,4 / 68,3; p=0,009). Mayor prevalencia en mujeres de hipertensión (80,8 vs 60,8%;p=0.001) y dislipemia (50,4 vs 39,9%;p=0.02) y menor prevalencia de tabaquismo (16 vs 48,6%;p=0.001), cardiopatía isquémica (9,2 vs 15,7%;p=0.05), EPOC (3,1 vs 13%;p=0.001) e isquemia crónica de MMII (25,2 vs42,6%; p=0.001). Uso de parche: 40,4% (38,3 / 50,4%; p=0,01). Mortalidad precoz: 1,6% (0 / 1,9%; p=0,2). Ictus perioperatorio: 3,2% (1,5 / 3,5%; p=0,4). Complicaciones cardiológicas: 3,8% (4,6 / 3,7%; p=0,6). Seguimiento mediano:62,5 meses; N=760 (629 hombres, 131 mujeres) Conclusiones: En nuestra serie el sexo no ha supuesto un factor de riesgo para la cirugía carotídea, con buenos resultados a corto y largo plazo, similares a los de los hombres.
    56º Congreso de la Sociedad Española de Angiología y Cirugía Vascular, Madrid; 06/2010
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    ABSTRACT: Objetivos: presentamos un caso de síndrome varicoso tratado mediante ablación ecoguiada con endoláser de safena externa y posterior flebectomía de colaterales varicosas. Paciente y Métodos: Mujer de 54 años que presenta varices en miembro inferior izquierdo tributarias de safena externa. Intervenida previamente de safenectomía interna derecha. CEAP: C2, Ep, As, Pr. Eco-Doppler preoperatorio: safena interna permeable y competente, safena externa insuficiente y dilatada desde el cayado hasta el tercio medio de pantorrilla con R3 que origina paquetes varicosos en región gemelar y dorso del pie. Anestesia tumescente. Canalización de safena externa en tercio medio-distal de pantorrilla mediante punción percutánea. Se coloca introductor de 6F y se avanza la fibra óptica hasta el cayado. Mediante Eco-Doppler se localiza la punta de la fibra a 2-3 cm del cayado. Ablación con láser de safena externa con una potencia de 8W y energía lineal de 100 Julios por centímetro. Posteriormente se realiza flebectomía de colaterales con técnica microquirúrgica de Müller. Resultados: La paciente es dada de alta una hora después de la cirugía, con vendaje compresivo durante 72 horas y posteriormente con medias elásticas. Eco-Doppler de control a la semana y al mes de la cirugía: SVP permeable y competente, persistencia de fibrosis de safena externa sin recanalización. Ausencia de sintomatología ortostática. Conclusiones: La ablación con endoláser es una técnica segura y eficaz para el tratamiento de las varices en MMII cuando se realiza bajo control ecogáfico de todo el procedimiento, que permite una recuperación postoperatoria más rápida que la cirugía convencional.
    56º Congreso de la Sociedad Española de Angiología y Cirugía Vascular, Madrid; 06/2010
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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.
  • Congreso SEC09 de la Sociedad Española de Cardiología, Barcelona; 10/2009
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    ABSTRACT: Introducción. El tratamiento de los pseudoaneurismas femorales (PSAF) mediante inyección de trombina se ha realizado con éxito en los últimos 10 años. Cardiología-Hemodinámica continúa intentando la compresión ecoguiada. El objetivo de este trabajo es determinar la eficacia y seguridad de cada tratamiento, en un mismo hospital. Material y Método De 2004 a 2009 (20.090 cateterismos) se han analizado un total de 143 (0.71%) PSAF diagnosticados por el Servicio de Cardiología-Hemodinámica. En el 49.65% se intentó la compresión (Grupo I=72). Ochenta y seis (Grupo II=86) fueron derivados para tratamiento con trombina. No existe criterio de derivación establecido. Cateterismo terapéutico en 58.73% de los casos. Se detalla protocolo compresión y punción. Resultados Trombosis Grupo I:(54/72) 75%; Grupo II:(83/86) 96.5%; p<0.05. Grupo I: Trombosis PSAF 1ª compresión (48/72) 52%, 2ª compresión (6/11) 54.5%. Tiempo medio: 79.6 min. Tamaño 3.26 cm (1.6-7). Tres pacientes con reacciones vagales y dos no toleraron la compresión. Grupo II: Trombosis PSAF con una punción (80/86) 93%; con segunda punción (3/5)60%. Tres pacientes requirieron intervención quirúrgica, uno tras aparición de signos inflamatorios y dos tras segunda punción fallida. Tiempo medio:13,7 min. Tamaño 3.88 cm (1-10). La dosis media de trombina fue de 401.16 UI. No recidivas a los tres meses seguimiento. Conclusiones Ambos procedimientos son seguros pero la inyección con trombina es más eficaz, y en nuestra opinión es el método de elección para el tratamiento de los PSFA. Sería deseable establecer protocolos conjuntos de actuación entre servicios para el tratamiento de los PSAF.
    Congreso SEC09 de la Sociedad Española de Cardiología, Barcelona; 10/2009
  • Fascículos de Avances en Cirugía Vascular. 01/2009;