J.M. Martín-Pedrosa

Hospital Clínico Universitario de Valladolid, Valladolid, Castille and León, Spain

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Publications (9)6.25 Total impact

  • José Miguel Martín-Pedrosa · Vicente Gutiérrez · José Antonio González-Fajardo · Carlos Vaquero
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    ABSTRACT: This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy.
    No preview · Article · May 2011 · Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
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    ABSTRACT: Introduction. The conventional treatment of complex aortic arch pathology requires invasive surgical approaches, with high morbidity and mortality rates. Combining open surgery and endovascular procedures can reduce the degree of surgical invasiveness. Aim. To determine short- and medium-term outcomes of hybrid repair of complex aortic arch pathologies by means of a prospective observation-based study. Patients and methods. Of a sample of 71 consecutive patients who underwent endovascular treatment of the thoracic aorta between January 2000 and June 2007, 10 required the use of hybrid techniques. The aortic pathologies that were treated were: three arteriosclerotic aneurysms (30%), three type B dissections (30%), three pseudoaneurysms (30%) and one aberrant right subclavian (10%). In one patient the stent had to be anchored in zone 0 (10%), six in zone 1 (60%) and three in zone 2 (30%). Results. Three patients were treated emergently (30%), initial clinical success being 90% and the total success, 100%. One patient died of pneumonia resulting from mechanical ventilation. Only one cerebrovascular accident (10%) was observed, with full clinical recovery. The patients with pseudoaneurysms and those who required anchoring in zone 1 spent a longer period of time in the Intensive Care Unit and also in the hospital ward. The mean follow-up time of the series was 13.5 months (range: 1-36 months), with survival of the whole series after the immediate post-operative period; there were no recurrences of the pathologies that had been treated in the operations or complications related to the endovascular device. Conclusions. The hybrid treatment of complex aortic arch pathologies does present a small incidence of spinal paralysis and mortality, but short- and medium-term outcomes are optimum.
    No preview · Article · Jan 2008 · Angiología
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    ABSTRACT: Introduction. Although arteriography is considered to be the reference standard for evaluation of peripheral arterial disease, the variations in its interpretation often lead to disparities in both diagnosis and in treatment. Aims. Our aim was to assess the diagnostic reliability of preoperative arteriography and to determine interobserver variability and accuracy, as well as the role it plays in making decisions about therapy. Patients and methods. A prospective study was designed in which 100 randomly selected angiography scans of lower extremities were examined by 3 vascular surgeons in a blind, independent manner. Arteries were classed as being patent, severely ill, occluded or not diagnosed at different levels. Agreement was expressed as κ values, and we analysed the therapeutic option proposed by each observer based on the patient record and angiography findings. Results. The percentage of arterial segments that were not identified in the preoperative arteriography (not diagnosed) was surprisingly high: 18% tibialis anterior; 21% tibialis posterior; 28% peroneal. Overall agreement was good in the aortic (κ = 0.78), iliac (κ = 0.76), femoral (κ = 0.61) and above-the-knee popliteal (κ = 0.64) segments; it was found to be moderate for the below-the-knee popliteal segment (κ = 0.50), and poor for the tibial branches (κ = 0.22). Although the 3 observers proposed identical treatment in 70% of the cases (κ = 0.65, high agreement), in 30% of cases the initial therapy plan based on the preoperative angiography did not coincide, and in 19% of cases this plan had to be modified to fit intraoperative findings. Conclusions. The important degree of interobserver variability seen in the evaluation of below-the-knee segments must be taken into account when other methods of diagnosis are compared to preoperative angiography. In this work we question its reliability, underline the need for intraoperative angiographie studies and call attention to an important bias in the interpretation of publications when attempts are made to compare this preoperative test with other non-invasive methods.
    No preview · Article · Sep 2005 · Angiología
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    ABSTRACT: Attempts to define and characterize the process of restenosis can be very complex, since most of the reports published on the matter are uncontrolled studies based on observation and only constitute level 3 evidence. The classical conception that the recurrence of stenosis was mainly due to an intimal hyperplasia phenomenon is now being replaced by the idea that there are two mechanisms that contribute to restenosis. The first involves arterial remodelling at the site of the lesion, which can account for up to 80% of the late lumen loss, and the second is hyperplasia caused by cellular proliferation. This fact, together with differences in species and the interaction of the atheroma plaque, explain the disparity between clinical and experimental findings. The aim of this study is to analyze the natural history of restenosis, to describe its incidence and to identify the etiopathogenic mechanisms responsible for the technical failure of endovascular therapy in the distal femoral-popliteal sector of the lower limbs.
    No preview · Article · May 2003 · Angiología
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    Preview · Article · Jun 2002 · European Journal of Vascular and Endovascular Surgery
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    ABSTRACT: Introduçã. Descrevemos uma técnica de reconstrução da arteria vertebral do segmento proximal. Realizámos uma transposição da artéria vertebral para o tronco tirocervical, e após ligação dos seus ramos, aproveitámos a dissecção para efectuar a anastomose. Doentes e métodos. Revimos retrospectivamente a nossa experiência: desde 1992 até 2001 realizámos a referida reconstrução em cinco doentes de sexo masculino, com sintomatologia verte-brobasilar, com idade média de 64 anos e com patologia carotídea comum ou interna ipsilateral e/ou carotídea interna contralateral. Técnica cirúrgica. Num primeiro tempo realizou-se a intervenção na carótida interna contralateral (n= 3). Ao fim de um mês, realizámos umaabordagem mediana ao esternocleidomastoideu, por incisâo oblí-qua supraclavicular, ao dissecar entre carótida principal e jugular interna vemos o nervo vago, o canal torácico e veia vertebral que ligamos, observando a artéria vertebral. Seccionámos a artéria vertebral abaixo da lesão. É necessário ter cuidado com a cadeia simpática cervical, o nervo vertebral e o gânglio simpático cervical inferior. Lateralmente na origem da vertebral nasce o tronco tirocervical, ligamos os seus ramos e sobre a dissecção realizámos a anastomose da artéria vertebralpor clampagem sub-clávia parcial. Resultados.Realizaram-se cinco transposiçôes, um doente sofreu AIT no pós-operatório imediato com recupera-ção sem sequelas. Durante o seguimento observou-se, por eco-Doppler, permeabili-dade de 100%, tendo apenas um doente falecido aos três anos por cardiopatia isquémica. Conclusão. Cremos que a transposição do segmento proximal da artéria vertebral ao tronco tirocervical é uma manobra cirúrgicapouco agressiva, sem clampagens dos troncos principais, que encurta o acto cirúrgico e reduz a baixa morbi-mortalidade.
    No preview · Article · Dec 2001 · Angiología
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    ABSTRACT: Introduction Arterial puncture in intravenous drug addicts can cause infected false aneurysms and may be accompanied by life-threatening hemorrhage, loss of limb, or death. Patients and methods Seven drug-addicted patients with infected false aneurysms were treated at our hospital from 1990 to 1999. The hallmark of diagnosis was a pulsatile mass with swelling, bleeding and purulent drainage. Arteriography distinguished abscess from false aneurysm and contributed to the anatomic location of the lesions. In all patients, arterial reconstruction was performed, either as elective (n = 3) or urgent (n = 4) surgery. Results Microbial culture was positive in all cases. A venous graft was used in 6 patients and a polytetrafluoroethylene (PTFE) graft was required in one patient with extinguished veins. Although the immediate postoperative period was normal, urgent arterial ligation was required in all patients due to reinfection and massive hemorrhage. Only one arm amputation was necessary. No deaths occurred. Conclusions Arterial reconstruction in drug addicts is accompanied by serious complications. Ligation and excision of the pseudoaneurysm without revascularization is safe and well-tolerated, with acceptable morbidity.
    No preview · Article · Dec 2001 · Cirugía Española
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    ABSTRACT: Introduction. We describe a technique for reconstruction of the proximal segment of the vertebral artery. We transposed the vertebral artery to the thyrocervical trunk after ligating its branches. The stump was used for anastomosis. Patients and methods. We made a retrospective review of our experience from 1992 to 2001. This reconstruction had been done in five male patients with vertebrobasilar symptoms. Their average age was 64 years and they had diseased common carotid or ipsilateral internal carotidand/or contralateral internal carotid arteries. Surgical technique: during the first stage of the reconstruction, the contralateral internal carotid artery was operated on (n= 3). One month later, using an approach medial to the sternocleidomastoid muscle, with an oblique supraclavicular incision, we dissected between the common carotid artery and internal jugular vein to find the vagus nerve, thoracic duct and vertebral vein, which was ligated, observing the vertebral artery. The vertebral artery was sectioned below the lesion. Great care was taken not to damage the cervical sympathetic chain, vertebral nerve or inferior cervical sympathetic ganglion. The thyrocervical trunk arises lateral to the origin of the vertebral artery. We ligated its branches and the vertebral artery was anastomosed to the stump using partial subclavian clamping. Results. Five transpositions were done. One patient had a TIA immediately after the operation but recovered with no sequelae. During the follow-up period, 100% permeability was shown by echo-Doppler. Only one patient died, three years later, from ischaemic cardiopathy. Conclusion. We believe that transposition of the proximal segment of the vertebral artery to the thyrocervical trunk is not a very aggressive surgical operation, which needs no clamping of the main arterial trunks, therefore reducing the operating time and giving low morbi-mortality.
    No preview · Article · Sep 2001 · Angiología
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    ABSTRACT: We present an unusual case of a lower descending thoracic aorta hydatidosis having ruptured into the mediastinal portion of the esophagus forming a fistula. Since localization of a hydatid cyst in the aorta wall is an exceptional manifestation even in endemic countries, it remains a difficult diagnosis, this is the first report of a complication of this type. Clinical features, surgical management, and a review of the literature are discussed.
    No preview · Article · Jan 1999 · Angiología