Browsing by Author "Gonzalez-Urquijo, Mauricio"

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    Extrinsic venous compression secondary to spine osteophytes
    (2023) Gonzalez-Urquijo, Mauricio; Torrealba, Jose; Francisco Vargas, Jose; Mertens, Renato; Marine, Leopoldo; Valdes, Francisco
    Objective This study aims to report two cases of symptomatic extrinsic compression of the inferior vena cava and left iliac vein caused by vertebral osteophytes. Methods We present two case reports of extrinsic venous compression by vertebral osteophytes. Both cases were endovascularly treated, with a successful outcome. A review of the literature of this unusual condition is also presented. Results The first patient is an 80-year-old woman who presented to the vascular surgery clinic with bilateral lower extremity edema and pain. A computed-tomography angiography (CTA) revealed extrinsic compression of the inferior vena cava from enlarged osteophytes. Venography and intravascular ultrasound were performed, confirming the diagnosis. A self-expanding venous stent was successfully deployed in the inferior vena cava relieving the extrinsic compression. The edema resolved the following day and was discharged without complications. The second patient is a 61-year-old male that presented to the emergency department with a left iliofemoral deep venous thrombosis. CTA showed left iliac vein compression by a lumbar osteophyte. Percutaneous thrombectomy was successfully achieved and an expanding stent was deployed covering the entire lesion. One month after the procedure the patient died from COVID-19-associated respiratory failure. Conclusion Osteophytes must be considered when dealing with extrinsic venous compression, especially in elderly people.
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    Isolated Abdominal Aortic Dissection With and Without Abdominal Aortic Aneurysm
    (2024) Gonzalez-Urquijo, Mauricio; Marine, Leopoldo; Valdes, Francisco; Vargas, Jose Francisco; Bergoeing, Michel; Mertens, Renato
    Objective The aim of this study was to report the clinical presentation and treatment outcomes of patients treated for IAAD with and without abdominal aortic aneurysm (AAA) in a single academic institution in South America.Materials and Methods A retrospective review of all patients with IAAD with or without concomitant AAA between January 2002 and December 2023 from a single academic hospital was performed.Results Eighteen patients with IAAD were diagnosed of whom 13 (72.2%) were males. Median age was 63 years (range: 43-88 years). Sixteen (88.8%) patients presented with symptoms, and in two (11.1%) asymptomatic patients IAAD was an incidental finding. Ten (55.5%) patients had concomitant abdominal aortic aneurysm (AAA), with a median size of the aneurysm of 49.5 mm (range: 44-66 mm). No statistical differences in baseline characteristics were seen between patients with concomitant IAAD and AAA and patients with only IAAD. Seven (38.8%) patients presented chronic dissection, and 11 (61.1%) patients had acute dissection. Five (27.7%) patients were treated conservatively with blood pressure, pain control, and antiplatelets; endovascular surgery was performed in eight (44.4%) patients and open surgery in five (27.7%) patients. The complication rate was 22.2% (n = 4), and the mortality rate was 0%. Median follow-up was 36 months (range: 6-240 months). Complete remodeling was seen in all patients except two patients who underwent conservative treatment. Of those, one had partial remodeling, and the other no changed.Conclusion Isolated aortic dissection of the abdominal aorta is an uncommon condition, with acceptable different treatment strategies, from conservative to invasive treatments. Sometimes IAAD can concur with AAA, and when so, invasive treatment might be considered. More studies describing the natural history of AAA and its association with IAAD are warranted, as well as further research reporting long-term outcomes on aortic remodeling after different treatment modalities.
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    Management of Spontaneous Isolated Celiac Artery Dissection
    (2024) Gonzalez-Urquijo, Mauricio; Vargas, Jose Francisco; Marine, Leopoldo; Mertens, Nicolas; Valdes, Francisco; Bergoeing, Michel; Mertens, Renato
    Background: Spontaneous isolated celiac artery dissection (SICAD) is uncommon, with very few series reported in the literature. The present study aims to describe the clinical characteristics and treatment outcomes of patients with SICAD treated at a single Chilean institution over 20 years. Methods: A retrospective review of all patients from a single academic hospital with SICAD diagnosed between January 2003 and March 2023 was performed. Conservative treatment included antiplatelets, anticoagulation, or both. The normal size of a celiac artery in our population was 7.9 +/- 0.79 mm in females and 8.3 +/- 1.08 mm in males. We defined a celiac artery with a diameter equal to or more than 12.5 mm as an aneurysmal celiac artery. Results: The cohort included 27 patients; 77.8% (n = 21) were males. The median age was 51.0 years (range: 38-84 years). Fourteen (51.8%) patients presented with aneurysmal dilatation. Fourteen (51.8%) patients were treated with antiplatelets, 6 (22.2%) patients with anticoagulation, and 7 (25.9%) with anticoagulation and antiplatelets. One patient was treated with endovascular therapy due to a pseudoaneurysm of the celiac artery detected 10 days after conservative treatment with antiplatelets. The median length of hospital stay was 5 days (range: 214 days). Complete remodeling was seen in 6 (22.2%) patients, partial remodeling in 10 (37.0%) patients, and no change was seen in 8 (26.9%) patients. Three (11.5%) patients were lost to follow-up. There were no significant differences between treatments and remodeling outcomes (P = 0.729). The median celiac artery diameter of patients with aneurysmal dilatation was 13.5 mm (range: 12.5-20.5 mm). Systemic arterial hypertension was found more commonly in patients who presented with aneurysmal dilatation than in patients without (87.5% vs. 12.5%, respectively, P = 0.016). Mean follow-up was 41.5 months and median follow-up was 16 months (range: 6-204 months). Conclusions: Most patients with SICAD can be treated conservatively with excellent outcomes. Hypertension was more commonly found in patients with SICAD and aneurysmal dilatation.
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    Pulmonary Aneurysmal Arteriovenous Malformation Treated With a Vascular Plug
    (2024) Gonzalez-Urquijo, Mauricio; Marchesini, Michelle; Marine, Leopoldo; Vargas, Jose Francisco; Bergoeing, Michel; Mertens, Renato; Valdes, Francisco
    Purpose To report a case of an asymptomatic patient with a pulmonary aneurysmal arterio-venous malformation successfully treated with a vascular plug.Case report An active 30-year-old male patient, residing at 3000 ft above sea level was referred due to an incidental finding on a CT scan of a 37 mm vascular mass localized in the lower lobe of the right lung, which corresponded to a pulmonary arteriovenous malformation with a single feeding artery. The patient was treated with an Amplatzer vascular plug, which effectively excluded the afferent vessel. An angio CT at 19 months follow-up revealed a hypodense residual mass of 9.0 mm in diameter with no arterial filling or venous drainage. The patient is fully active and remains asymptomatic at 24 months follow-up.Conclusion An unusual case of a pulmonary aneurysmal arteriovenous malformation successfully treated with a vascular plug is presented, highlighting the efficiency of this procedure.
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    Survey-Based Assessment of the Quality of Reporting Guidelines of Carotid Artery Stenosis
    (2024) Gonzalez-Urquijo, Mauricio; Gomez-Gutierrez, Oliver Antonio; Hinojosa-Gonzalez, David E.; Reijnen, Michel M. P. J.; van den Berg, Jos C.; Vegas, Diego Herrera; Marine, Leopoldo; Lozano-Balderas, Gerardo; Fabiani, Mario Alejandro
    Background: No evaluation of the quality of different carotid guidelines using validated scales has been performed to date. The present study aims to analyze 3 carotid stenosis guidelines, apprizing their quality and reporting using validated tools. Methods: A survey-based assessment of the quality of the European Society for Vascular Surgery (ESVS) 2023, European Stroke Organisation (ESO) 2021, and the Society for Vascular Surgery (SVS) 2021 carotid stenosis guidelines, was performed by 43 vascular surgeons, cardiologists, neurologist or interventional radiologists using 2 validated appraisal tools for quality and reporting guidelines, the AGREE II instrument and the RIGHT statement. Results: Using the AGREE II tool, the ESVS, SVS, and ESO guidelines had overall quality scores of 87.3%, 79.4%, and 82.9%, respectively (P = 0.001) The ESVS and ESO had better scores in the scope and purpose domain, and the SVS in the clarity of presentation domain. In the RIGHT statement, the ESVS, SVS, and ESO guidelines had overall quality scores of 84.0.7%, 74.3%, and 79.0%, respectively (P = 0.001). All 3 guidelines stood out for their methodology for search of evidence and formulating evidence-based recommendations. On the contrary, were negatively evaluated mostly in the cost and resource implications in formulating the recommendations. Conclusions: The 2023 ESVS carotid stenosis guideline was the best evaluated among the 3 guidelines, with scores over 5% higher than the other 2 guidelines. Efforts should be made by guideline writing committees to take the AGREE II and RIGHT statements into account in the development of future guidelines to produce high-quality recommendations.
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    Thirty-three vascular residency programs among 13 countries joining forces to improve surgical education in times of COVID-19: A survey-based assessment
    (2022) Fabiani, Mario Alejandro; Gonzalez-Urquijo, Mauricio; Cassagne, Gabriela; Dominguez, Angeles; Hinojosa-Gonzalez, David Eugenio; Lozano-Balderas, Gerardo; Cisneros Tinoco, Miguel angel; Escotto Sanchez, Ignacio; Esperon Percovich, Alejandro; Vegas, Diego Herrera; Marine Massa, Leopoldo; Mertens, Renato A.; Morelli, Luis; Sepulveda Monsalve, Gustavo; Sanchez Nicolat, Nora; Perez Damian, Venancio; Riambau, Vicente; Vaquero Puerta, Carlos; Zaefferer, Patricio
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    True Idiopathic Brachial Artery Aneurysm Treated With a Saphenous Vein Graft
    (2022) Gonzalez-Urquijo, Mauricio; Marine, Leopoldo; Vargas, Jose Francisco; Valdes, Francisco; Mertens, Renato; Bergoeing, Michel; Torrealba, Jose
    Purpose: The objective of this study is to report a case of a 65-year-old woman who presented with pallor and pain of her left arm secondary to a true arterial brachial aneurysm, which was successfully treated with saphenous vein bypass and embolization of the aneurysm sac. A review of the literature is also presented. Case report: A 65-year-old woman presented with an acute onset of pallor and pain of her left forearm, and hand. On physical examination, there was a pulsatile mass at the forearm. A doppler ultrasound showed a fusiform aneurysmal dilatation of the brachial artery of 23 mm of diameter. A dynamic contrast-enhanced MRI angiogram confirmed a fusiform dilation of the distal brachial artery. The patient was scheduled for open repair. A fusiform 20 x 60 mm aneurysm of the distal brachial artery extending to the cubital fossa was found and a brachial artery to radial and ulnar arteries bypass with interposed reverse right saphenous vein was created. Embolization of the aneurysm sac was performed using Gelita-spon (R) (Gelita Medical, Eberbach, Germany). A final angiogram showed an adequate perfusion through the bypass to the hand, and no contrast in the aneurysmal sac. Postoperative course was uneventful with discharge on the fourth postoperative day. Conclusion: Revascularization with autologous saphenous vein graft and exclusion of the aneurysm with local embolization is a good treatment alternative in a patient with symptomatic brachial aneurysm with distal embolization.