M.A. Cairols

Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Catalonia, Spain

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Publications (59)82.36 Total impact

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    ABSTRACT: Objective To analyse the long term results (4 years) of the by-pass femorodistals to only trunk in critical ischemia of the extremity comparing patency and limb salvage rate according to receiving artery. Method Study of 102 femorodistal bypass in 94 patients (66 males, 28 women), with a mean age of 70 years (r= 43-92). Approaches inclusion: critical ischemia of the extremity, proximal anastomosis in common femoral, only one distal artery permeable (42 peroneal artery, 39 anterior tibial artery, 21 posterior tibial artery), and saphenous vein was used graft material (82 in situ, 20 reversed).To compare the groups we have used chi-square or t Student. Patency bypass and limb salvage rate were evaluated by Kaplan-Meier (test Log-Rank). The number of minor amputations associated was determined. Results To 4 years, global patency bypass was 42% (45% anterior tibial, 44% posterior tibial, 41% peroneal), without existing statiscally significant differences (Log rank= 0,51). The global limb salvage was 58% (55% anterior tibial, 54% posterior tibial, 59% peroneal), without statiscally significant differences (Log rank= 0,5). The number of amputations minor associates was higher when the receiving artery was the peroneal (p= 0,007). Conclusions The peroneal artery for femorodistal bypass is useful in limb salvalge. A higher number of minor amputations are associates when the receiving artery is the peroneal.
    No preview · Article · Aug 2013 · Angiología
  • E. Iborra · P. Linares · E. Hernández · R. Vila · M.A. Cairols
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    ABSTRACT: Aim To compare clinical results after vein stripping with those obtained after CHIVA technique. Material and method This is a prospective and randomised clinical study in 100 patients from the varicose vein waiting list of our hospital. They were 62 women and 38 men, mean age of 49 years. Inclusion criteria were those recommended by the SEAC. All those patients with past history of DVT or incompetence of the deep venous system and previous therapies (sclerotherapy or surgery) were excluded. An ATL Ultramark 9HDI colour duplex was used to carry out a venos haemodynamic mapping were carried out in all patient. Patients were allocated at random in two groups, Group I, vein stripping 49 patients, and Group II, CHIVA technique: 51 patients. Both groups were similar as far as the CEAP classification was concerned. Clinical and haemodynamic follólo up were carried out at 7 days and thereafter at 1,3 and 6 months from surgery. Results Mean workdays loss was 19.2 days in group I and 7.8 days in group II. Traumatic saphenous nerve neuritis were present in 22.4% of cases in group I, whereas 7.5% in group 11 showed symptomatic long saphenous vein phlebitis. It can be stressed than duplex detected 21.5% of phlebitis at 1 month and 1.9% at 6 month from surgery. Clinical and aesthetic results at 6 months of the postoperative period did not show any statistical differences (chi-square and t Student) betiveen the two treatments. Conclusions Both techniques for treating patients with varicose veins are similar in the immediate postoperative period. There was though a shorter recovery in the CHIVA method of therapy with less workday lost. Complications such as neuritis were more frequent in the stripping group whereas phlebitis were the main complication in the CHIVA group.
    No preview · Article · Aug 2013 · Angiología
  • Xavier Martí · Antoni Romera · Ramon Vila · Marc A Cairols
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    ABSTRACT: To assess the role of ultrasound arterial mapping in planning therapeutic options for critical limb ischemia (CLI) in diabetic patients. This observational and comparative study included 244 patients with CLI. All participants (64% were diabetic) underwent ultrasound arterial mapping before planning surgical treatment. We established two groups: diabetic (n = 156) and nondiabetic (n = 88). Arterial mapping was divided into segments. We studied 2,021 individual segments and used arteriography when ultrasound arterial mapping was not conclusive. We compared the degree of pathology between the groups, agreement between the treatment decision made after ultrasound mapping and the final surgical decision in both groups, and agreement between ultrasound mapping and arteriography in patients who underwent both procedures. Diabetic patients had a significantly higher degree of pathology in all segments, except the common iliac artery. Decisions made after ultrasound mapping matched the final surgical decision 90% and 94% of the time in diabetic patients and nondiabetic patients, respectively. Decisions made on the basis of ultrasound arterial mapping matched decisions made on the basis of arteriography in 86.3%. Ultrasound arterial mapping allowed for good therapeutic planning for CLI in diabetic patients, even though these patients had more severe arterial pathology.
    No preview · Article · Jul 2012 · Annals of Vascular Surgery
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    ABSTRACT: Background and objectivesCritical leg ischemia (CLI) is a medical emergency with a high morbidity and mortality. Although its prognosis has improved during the last years, there are no data on its clinical characteristics, treatment and in-hospital prognosis in our country.Patients and method671 patients (81% males, mean age 71.2 years) with atherosclerotic CLI, attended in 46 departments of vascular surgery were included in the study.ResultsParticipants had a high prevalence of cardiovascular risk factors (72% hypertensive, 27% current smokers, 59% diabetics) and comorbidity (25% coronary heart disease, 18% cerebrovascular disease). 71% had a previous diagnosis of peripheral arterial disease. Upon admission, 71% were referred for revascularization, 5% for direct amputation and 24% for conservative treatment. During hospitalization 22 patients died and 49 were discharged with a major amputation. On multivariate analysis, the only factor associated with the risk of amputation was gangrenous lesions (OR 2.45; IC95% 1.22-4.92). Factors associated with mortality were the presence of chronic renal failure (OR 3.38; IC95% 1.36-8.39) and previous CLI (OR 0.20; IC95% 0.05-0.89). At discharge, 59% received lipid lowering drugs, 70% blood-pressure lowering medications and 85% antiplatelet drugs.ConclusionCLI patients attended in Spanish vascular surgery departments have a low amputation rate and a low hospital mortality. However, and due to their high cardiovascular risk, it is necessary to improve the prescription rate of evidence-based cardiovascular prevention therapies at discharge.
    No preview · Article · Feb 2011 · Medicina Clínica
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    ABSTRACT: Critical leg ischemia (CLI) is a medical emergency with a high morbidity and mortality. Although its prognosis has improved during the last years, there are no data on its clinical characteristics, treatment and in-hospital prognosis in our country. 671 patients (81% males, mean age 71.2 years) with atherosclerotic CLI, attended in 46 departments of vascular surgery were included in the study. Participants had a high prevalence of cardiovascular risk factors (72% hypertensive, 27% current smokers, 59% diabetics) and comorbidity (25% coronary heart disease, 18% cerebrovascular disease). 71% had a previous diagnosis of peripheral arterial disease. Upon admission, 71% were referred for revascularization, 5% for direct amputation and 24% for conservative treatment. During hospitalization 22 patients died and 49 were discharged with a major amputation. On multivariate analysis, the only factor associated with the risk of amputation was gangrenous lesions (OR 2.45; IC95% 1.22-4.92). Factors associated with mortality were the presence of chronic renal failure (OR 3.38; IC95% 1.36-8.39) and previous CLI (OR 0.20; IC95% 0.05-0.89). At discharge, 59% received lipid lowering drugs, 70% blood-pressure lowering medications and 85% antiplatelet drugs. CLI patients attended in Spanish vascular surgery departments have a low amputation rate and a low hospital mortality. However, and due to their high cardiovascular risk, it is necessary to improve the prescription rate of evidence-based cardiovascular prevention therapies at discharge.
    No preview · Article · Nov 2010 · Medicina Clínica
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    ABSTRACT: Aortic stent-graft infections (ASGIs) are associated with significant mortality. We report our experience of two cases of ASGI treated differently and successfully. Two patients presented with constitutional symptoms some months after scheduled endovascular repair of aortic aneurysm (EVAR). Patient 1 had an abscess formation around the endograft in continuity with the right groin. Due to patient comorbidities, a conservative treatment was performed. Patient 2 had an abscess formation with air surrounding the stent graft. The patient was treated successfully by endograft removal. Computed tomographic scan follow-up at 6 months from surgery showed no evidence of recurrent infection. Despite the recommended treatment of ASGI being surgery, conservative treatment can be performed successfully in patients with high surgical risk, avoiding aortic clamping. We present the first reported case of ASGI due to Streptococcus haemolyticus, the second case due to a fungus, and the second reported case of spondylodiscitis after EVAR.
    Full-text · Article · May 2010 · Annals of Vascular Surgery
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    ABSTRACT: Rationnelle Les infections d’endoprothèse aortique (IEPA) sont grevées d’une mortalité significative. Nous rapportons notre expérience de 2 cas traités différemment avec succès. Méthodes Deux patients se sont présentés avec des symptômes quelques mois après implantation réglée d’endoprothèse aortique (EVAR). Le patient 1 avait une collection abcédée autour de l’endoprothèse en continuité avec le scarpa droit. Du fait de ses comorbidités, un traitement conservateur a été réalisé. Le patient 2 avait une collection abcédée avec présence de bulles d’air autour de l’endoprothèse. Il a été traité avec succès par ablation chirurgicale de l’endoprothèse. Résultats Le scanner de contrôle à 6 mois postopératoire ne montrait aucun signe de récidive d’infection. Conclusion Bien que le traitement recommandé des IEPA soit chirurgical, le traitement conservateur peut être utilisé avec succès chez les patients à haut risque chirurgical, évitant ainsi le clampage aortique. Nous rapportons le premier cas d’IEPA à Streptococcus haemolyticus, le second cas du à une infection fungique et le deuxième cas rapporté de spondylodiscite après EVAR.
    No preview · Article · May 2010 · Annales de Chirurgie Vasculaire

  • No preview · Article · Oct 2009 · Medicina Clínica
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    ABSTRACT: To evaluate the prevalence of both non-calf intermittent claudication (IC) and classic IC in patients with no known atherosclerotic disease, and their accuracy to detect peripheral arterial disease (PAD). Cross sectional, observational study conducted at 96 internal medicine services. 1487 outpatients with no known atherosclerotic disease, and either diabetes or a SCORE risk estimation of at least 3% were enrolled. IC was assessed using the Edinburgh Claudication Questionnaire and PAD was confirmed by an ankle-brachial index (ABI) <0.9. Overall, 7.2% met criteria of classic and 5.8% of non-calf IC. PAD was diagnosed in 393 cases (26.4%). In these PAD patients, 17.8% exhibited classic and 13.2% non-calf IC. Both calf and non-calf IC had similar overall accuracy for detecting PAD. Considering both categories as a whole, the sensitivity of IC to predict a low ABI was 31% and the specificity 93%. Non-calf IC is comparable to classic IC for the diagnosis of PAD in patients with no known arterial disease. The systematic implementation of Edinburgh Claudication Questionnaire could be a valuable call-to-action to improve clinical evaluation of PAD, bearing in mind that PAD detected by either non-calf or classic IC must be confirmed by ABI testing.
    No preview · Article · Aug 2009 · European Journal of Internal Medicine
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    Full-text · Article · Jul 2009 · Medicina Clínica
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    ABSTRACT: The REACH Registry is the largest worldwide designed to obtain information on cardiovascular risk factor control and preventive treatment in a population who have, or are at risk of having, symptoms of atherothrombosis. The objective of this study is to show the results of cardiovascular events obtained in a sample of the Spanish population at one year follow-up and intervention. The REACH Spain registry is a prospective cohort study of subjects with vascular risk factors (ORF) for atherothrombosis or with symptomatic vascular disease (VD): coronary artery disease (CAD) and/or cerebrovascular disease (CVD) and/or peripheral artery disease (PAD). The main outcome measures were rates of all-cause mortality, cardiovascular (CV) death, and the overall combined CV death, myocardial infarction (MI), or stroke and CV hospitalization at one year follow-up. In Spain 2,516 patients were recruited and 2,252 completed one year follow-up, the mean age was 68,1 (73,8% men), 11,6% of subjects with ORF and 88,5% with VD, 55% with CAD, 33% with CVD and 17% with PAD. The annual rate of all-cause mortality in VD and ORF groups were 3,57% and 1,98% (NS) respectively, while for CV death they were 2,69% and 0,62% (P<.05) and for overall combined CV death myocardial infarction (MI), or stroke and CV hospitalization they were 15,34% and 5,47% (P=.0001). The annual rate of CV death for CAD, CVD and PAD groups were 3,47%, 2,78% and 1,46% respectively, and for the overall combined CV death, myocardial infarction (MI) , or stroke and CV hospitalization they were 18,52%, 13,75% and 14,52%. These event rates increased with the number of symptomatic arterial disease locations from 0,1,2 or 3 for CV death (0,62%, 2,46%, 3,55% and 4,32%, respectively P<.05) and for overall combined CV death myocardial infarction (MI), or stroke and CV hospitalization (5,50%, 4,18%, 20,59% y 19,40%, respectively P<.0001). At one year follow-up, 82,8% of the patients were with at least one antiplatelet drug and 86,2% were receiving lipid-lowering agents. The REACH Spain Registry at one year follow-up in patients with atherothrombotic disease or at risk of having symptoms of atherothrombosis shows a high rate of all-cause mortality and of overall combined major CV events, which is becoming higher as the number of symptomatic arterial disease locations increases.
    No preview · Article · May 2009 · Medicina Clínica
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    ABSTRACT: Background and objectiveThe REACH Registry is the largest worldwide designed to obtain information on cardiovascular risk factor control and preventive treatment in a population who have, or are at risk of having, symptoms of atherothrombosis. The objective of this study is to show the results of cardiovascular events obtained in a sample of the Spanish population at one year follow-up and intervention.
    No preview · Article · Apr 2009 · Medicina Clínica
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    A Romera · M.A. Cairols · R Vila-Coll · X Martí · E Colomé · A Bonell · O Lapiedra
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    ABSTRACT: To evaluate whether low-molecular-weight heparin (LMWH) could be equally (or more) effective than oral anti-vitamin-K agents (AVK) in the long-term treatment of deep venous thrombosis (DVT). A randomised, open-label trial. In this trial, 241 patients with symptomatic proximal DVT of the lower limbs confirmed by duplex ultrasound scan were included. After initial LMWH, patients received 6 months of treatment with full therapeutic dosage of tinzaparin or acenocoumarol. The primary outcome was the 12-month incidence of symptomatic recurrent venous thrombo-embolism (VTE). Duplex scans were performed at 6 and 12 months. During the 12-month period, six patients (5%) of 119 who received LMWH and 13 (10.7%) of 122 who received AVK had recurrent VTE (p=0.11). In patients with cancer, recurrent VTE tended to be lower in the LMWH group (two of 36 [5.5%]) vs. seven of 33 [21.2%]; p=0.06). One major bleeding occurred in the LMWH group and three in the AVK group. Venous re-canalisation increased significantly at 6 months (73.1% vs. 47.5%) and at 12 months (91.5% vs. 69.2%) in the LMWH group. Tinzaparin was more effective than AVK in achieving re-canalisation of leg thrombi. Long-term tinzaparin was at least as efficacious and safe as AVK for preventing recurrent VTE, especially in patients with cancer.
    Full-text · Article · Mar 2009 · European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery
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    ABSTRACT: Patients with polyvascular disease have an increased rate of cardiovascular events and death. Their identification would define a subgroup of the population at very high risk, who would be candidates to intensified preventive measures. The objective of the present study was to evaluate the prevalence of subclinical peripheral artery disease in subjects with a previous diagnosis of vascular disease in other territories. Subjects with a coronary or a cerebrovascular event between 3 months and 5 years, and who were attended at internal medicine outpatient clinics from Spain were included in the study. All patients had a clinical history, a physical examination, a blood and urine analysis, and a measurement of the ankle-brachial index (ABI). A total of 1203 patients (64% males; mean age: 74.3 years), were included in the study. A previous coronary event was reported in 55.4% of the participants, cerebrovascular disease in 38%, and a clinical history of disease in both territories in 6.7%. The prevalence of a low ABI (< 0,9) was 33.8%, 32.4% and 53.9% for each group, respectively. In a multivariate analysis, factors associated with a low ABI were age, smoking habit, diabetes, a reduced glomerular filtration rate, systolic blood pressure and the presence of clinical disease in both territories upon inclusion. The sensitivity of both, the Edinburgh questionnaire and pulse palpation for detecting and ABI below 0.9, were low. Prevalence of a low ABI is elevated in asymptomatic patients with coronary or cerebrovascular disease, particularly if there are clinical manifestations in both territories.
    No preview · Article · Nov 2008 · Medicina Clínica
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    ABSTRACT: Background and objective Patients with polyvascular disease have an increased rate of cardiovascular events and death. Their identification would define a subgroup of the population at very high risk, who would be candidates to intensified preventive measures. The objective of the present study was to evaluate the prevalence of subclinical peripheral artery disease in subjects with a previous diagnosis of vascular disease in other territories. Patients and method Subjects with a coronary or a cerebrovascular event between 3 months and 5 years, and who were attended at internal medicine outpatient clinics from Spain were included in the study. All patients had a clinical history, a physical examination, a blood and urine analysis, and a measurement of the ankle-brachial index (ABI). Results A total of 1203 patients (64% males; mean age: 74.3 years), were included in the study. A previous coronary event was reported in 55.4% of the participants, cerebrovascular disease in 38%, and a clinical history of disease in both territories in 6.7%. The prevalence of a low ABI (< 0,9) was 33.8%, 32.4% and 53.9% for each group, respectively. In a multivariate analysis, factors associated with a low ABI were age, smoking habit, diabetes, a reduced glomerular filtration rate, systolic blood pressure and the presence of clinical disease in both territories upon inclusion. The sensitivity of both, the Edinburgh questionnaire and pulse palpation for detecting and ABI below 0.9, were low. Conclusions Prevalence of a low ABI is elevated in asymptomatic patients with coronary or cerebrovascular disease, particularly if there are clinical manifestations in both territories.
    No preview · Article · Nov 2008 · Medicina Clínica
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    ABSTRACT: Massive and/or recurrent hemoptysis is a clear indication for surgical treatment of pleuropulmonary aspergilloma, despite the incidence of postoperative morbidity and mortality. Thoracoplasty has been widely used for 20 years and is still indicated in these cases, following lobectomy, even though the procedure is not free of complications. We report the case of a patient who required thoracoplasty to treat a pleuropulmonary aspergilloma invading the chest wall. Subsequent placement of an aortic stent-graft was required due to tearing of the left subclavian artery.
    No preview · Article · Jul 2008 · Archivos de Bronconeumología
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    ABSTRACT: We evaluated the association between a low ankle-brachial index (ABI), chronic complications of diabetes, and the presence of traditional cardiovascular disease risk factors in subjects with type 2 diabetes but without known cardiovascular disease. We included diabetic subjects (n=923; 52% male; age range 50-85 years) without clinical evidence of coronary, cerebrovascular, or peripheral artery disease (PAD). A history of nephropathy, retinopathy, or neuropathy was collected from the medical records. A 12-lead electrocardiogram and ABI measurements were conducted on all study participants. The mean duration of diabetes was 9.6 years. Prevalence of a low ABI (<0.9) was 26.2%. Multivariate analysis indicated that factors significantly associated with a low ABI were age (OR: 1.06; 95%CI: 1.033-1.084; p<0.001), plasma triglyceride concentration (OR: 1.002; 95%CI: 1.001-1.004; p=0.006), duration of diabetes (OR: 1.029; 95%CI: 1.008-1.051; p=0.007), and smoking habit (OR: 1.755; 95%CI: 1.053-2.925; p=0.03). The presence of nephropathy, neuropathy, retinopathy, left ventricular hypertrophy, left bundle branch block, and atrial fibrillation were all associated with a low ABI, but only renal disease remained significant after adjusting for age, duration of diabetes, and cardiovascular risk factors. A low ABI is highly prevalent in subjects with diabetes and is related to age, duration of diabetes, smoking habit, and hypertriglyceridemia. Although chronic complications are frequently associated with a low ABI, only renal damage is independently associated with peripheral artery disease.
    No preview · Article · Jul 2008 · European Journal of Internal Medicine
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    ABSTRACT: Massive and/or recurrent hemoptysis is a clear indication for surgical treatment of pleuropulmonary aspergilloma, despite the incidence of postoperative morbidity and mortality. Thoracoplasty has been widely used for 20 years and is still indicated in these cases, following lobectomy, even though the procedure is not free of complications. We report the case of a patient who required thoracoplasty to treat a pleuropulmonary aspergilloma invading the chest wall. Subsequent placement of an aortic stent-graft was required due to tearing of the left subclavian artery.
    No preview · Article · Jun 2008 · Archivos de Bronconeumología
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    ABSTRACT: Cellular Prion Protein (PrPc) is a ubiquitous glycoprotein present on the surface of endothelial cells. Resting vascular endothelial cells show minimum expression of PrPc and can constitutively release PrPc. PrPc participates in cell survival, differentiation and angiogenesis. During development, neonatal brain endothelial cells transiently express PrPc. Our group recently reported upregulation of PrPc in microvessels from ischemic brain regions in stroke patients. Ischemia/hypoxia induces PrPc expression through the activation of extracellular signal-regulated kinase (ERK). All these data suggest that PrPc plays an important role in angiogenic responses. In addition, PrPc participates in cellular function in the central nervous system, since PrPc is also highly expressed in neurons. PrPc binds copper, suggesting a role in copper metabolism. PrPc also protects cells against oxidative stress and it seems to be involved in neuroprotection. Several studies have demonstrated that PrPc prevents cells from apoptosis and subsequent tissue damage. Moreover, PrPc plays an important role in the immune response. Here, we review the multiple functions of PrPc with a special attention to its recently reported role in angiogenesis.
    Full-text · Article · Feb 2008 · Frontiers in Bioscience
  • A. Romera · L. Rodriguez · M. Cairols

    No preview · Article · Oct 2007 · Anales de Patologia Vascular

Publication Stats

492 Citations
82.36 Total Impact Points

Institutions

  • 1985-2012
    • Hospital Universitari de Bellvitge
      • • Department of Angiology and Vascular Surgery
      • • Department of Neurology
      l'Hospitalet de Llobregat, Catalonia, Spain
  • 2009
    • University of Barcelona
      Barcino, Catalonia, Spain
  • 2008
    • The University of Manchester
      Manchester, England, United Kingdom