Browsing by Author "Marine Massa, Leopoldo Ario Fernando"
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- ItemAneurisma de aorta abdominal roto al duodeno: causa infrecuente de hemorragia digestiva masiva(2021) Marine Massa, Leopoldo Ario Fernando; Mertens Martin, Renato Alfonso; Torrealba Fonck, José Ignacio; Valdés Echenique, José Francisco; Bergoeing Reid, Michel Paul; Vargas, Francisco; Yañez Moya, Hugo EnriquePrimary aortoenteric fistula is the spontaneous communication between the lumen of the aorta and a portion of the digestive tract. The most common cause is the erosion of an abdominal aortic aneurysm into the 3rd or 4th portion of the duodenum. It manifests clinically as gastrointestinal bleeding, with or without abdominal pain and a pulsatile abdominal mass on physical exam. Gastrointestinal bleeding is initially recurrent and self-limiting and progresses to fatal exsanguinating hemorrhage. Endoscopic examination diagnoses only 25% of aortoenteric fistulas because these are usually located in the distal duodenum. Contrast computed tomography of the abdomen and pelvis is diagnostic in only 60% of cases. We report three cases with this condition. A 67-year-old male presenting with an upper gastrointestinal bleeding. He was operated and a communication between an aortic aneurysm and the duodenum was found and surgically repaired. The patient is well. A 67-year-old male with an abdominal aortic aneurysm presenting with abdominal pain. He was operated and anticoagulated. In the postoperative period he had a massive gastrointestinal bleeding and a new CAT scan revealed an aorto enteric fistula that was surgically repaired. The patient is well. An 82-year-old male with an abdominal aortic aneurysm presenting with hematochezia. A CAT scan revealed a communication between the aneurysm and the third portion of the duodenum, that was surgically repaired. The patient died in the eighth postoperative day.
- ItemCoronary-subclavian steal syndrome: A case series and review of the literature(2024) González Urquijo, Mauricio; Valdés Echenique, José Francisco; Bulnes Muzard, Juan Francisco; Torres Álvarez, Josemaría; Vargas Serrano, José Francisco; Bergoeing Reid, Michel Paul; Mertens Martin, Renato Alfonso; Marine Massa, Leopoldo Ario FernandoObjective: To report a case series of three patients with symptomatic coronary-subclavian steal syndrome (CSSS) and to review the literature on published case series. Methods: We retrospectively reviewed three cases of CSSS patients treated with open and endovascular surgery at a single center over a period of three decades (1996–2024). A comprehensive review of case series involving more than three patients was also performed. Results: The first patient was a 65-year-old male with a 12-year history of coronary artery bypass grafting (CABG), presenting with unstable angina. Coronary angiography revealed a patent left internal mammary artery (LIMA) graft with retrograde flow through the left subclavian artery (LSA) and occlusion at the LSA ostium. He underwent a successful carotid-subclavian bypass, which significantly improved his symptoms. He died 6 years later from heart failure. The second patient was a 73-year-old woman with a 15-year history of CABG and balloon angioplasty of the grafts. She presented with dyspnea, stable angina, and progressive functional decline. Critical stenosis in the LSA was identified, and her symptoms resolved after successful stent placement. She died 6 years later from progressive heart failure. The third patient was a 75-year-old woman with diabetes, hypertension, and heart failure, who also had a history of CABG. She presented with worsening dyspnea, orthopnea, and edema. Imaging revealed occlusion of the circumflex artery graft and severe LSA stenosis. Successful stenting of the LSA alleviated her symptoms and restored normal blood flow from the LIMA graft. She was discharged after 2 days and remains well at the six-month follow-up. Conclusion: CSSS should be considered in the differential diagnosis of patients with a history of CABG who present with angina or heart failure. Prompt treatment can lead to significant symptom improvement.
- ItemDolor pélvico crónico secundario a síndrome de congestión pélvica. Resultados del tratamiento endovascular de la insuficiencia venosa pelviana y várices genitales(SOC MEDICA SANTIAGO, 2019) Drazic Beni, Obren Danilo; Zarate Bertoglio, Cristian Fernando; Valdés Echenique, José Francisco; Mertens Martin, Renato Alfonso; Bergoeing Reid, Michel Paul; Kramer Schumacher, Albrecht Helmuth; Marine Massa, Leopoldo Ario Fernando; Vargas Serrano, José FranciscoBackground: Pelvic venous insufficiency may cause pelvic congestion syndrome that is characterized by chronic pelvic pain exacerbated by prolonged standing, sexual activity or menstrual cycle. It may be treated by embolizing the dysfunctional pelvic venous drainage and sometimes resecting vulvar, perineal and thigh varices. Aim: To assess the results of embolization of insufficient pelvic or ovarian veins on pelvic congestion syndrome. Material and Methods: Analysis of 17 female patients aged 32 to 53 years, who underwent subjected to a selective coil embolization of insufficient pelvic and/or ovarian veins through the jugular, basilic or cephalic veins. In the preoperative period, all patients had a lower extremity venous duplex pelvic ultrasound examination and some had an abdominal and pelvic CT angiogram. Results: The technical success of the procedure was 100% and no complications were registered. During a 32 month follow up, no patient had symptoms of pelvic venous insufficiency or relapse of vulvar or thigh varices. Conclusions: Embolization of insufficient pelvic and ovarian veins is a safe and successful procedure for the treatment of pelvic venous insufficiency or vulvar varices.
- ItemFiltros de vena cava inferior en posición suprarrenal(2008) Marine Massa, Leopoldo Ario Fernando; Mertens Martin, Renato Alfonso; Kramer Schumacher, Albrecht Helmuth; Valdés Echenique, José Francisco; Bergoeing Reid, Michel Paul; Arriagada Jorquera, Ivette Andrea; Vergara González, Teresa Jeanette; Carvajal Núñez, Claudia XimenaBackground: Inferior vena cava (IVC) filters are used to prevent massive pulmonary embolism in cases where anticoagulation is contraindicated or has failed. It is usually implanted below the renal veins. In a few cases it is necessary to deploy the filter above them, with theoretical risk of secondary renal failure. Aim: To report the experience with filters located above the renal veins. Patients and Methods: Medical records of all patients with percutaneous suprarenal filters are reviewed. Results: Between May 1993 and May 2007, 361 percutaneous IVC filter procedures were performed. In thirty patients aged 19 to 77 years (average 48 years, 50% males), they were placed in suprarenal position (8.3%). Suprarenal IVC filters were implanted in patients with extensive caval thrombosis, renal vein thrombosis extending to cava, displacement of previous IVC filters and double IVC system. Jugular vein approach was the access of choice. Technical success was 100%, no death or pulmonary embolism occurred. Patients were followed from 1 to 165 months (average 57 months). Eight deaths were recorded, five in patients with cancer. No patient had renal failure on follow up (average creatinine 0.90 +/- 0,26 mg/dL). Three patients developed a new deep vein thrombosis (10%), without pulmonary of IVC filters was not associated to secondary renal failure, and showed suprarenal placement of IVC filters was not associated to secondary renal failure, and showed good short and long term results (Rev Med Chile 2008; 136: 1535-41).
- ItemManejo del aneurisma de la aorta abdominal: Estado actual, evidencias y perspectivas para el desarrollo de un programa nacional(2009) Marine Massa, Leopoldo Ario Fernando; Valdés Echenique, José Francisco; Mertens Martin, Renato Alfonso; Kramer Schumacher, Albrecht Helmuth; Bergoeing Reid, Michel Paul; Rivera D., Dixiana; Vergara G., Jeanette; Carvajal Núñez, Claudia XimenaOpen and endovascular surgery are therapeutic allernatives for the treatment of abdominal aortic aneurism. The development of guidelines for its treatment requires a thorough analysis of available evidence to recommend the best treatment for each country's reality. Prospective randomized trials have shown best initial results with endovascular surgery, with higher hospital costs than open surgery. The requirement of anatomical suitability for the placement of endovascular prostheses limits the universal use of endovascular surgery. Moreover, this type of surgery needs a strict imaging and clinical follow up due to the high rates of late complications, which range from 20% to 40%. Many of these complications require further surgical interventions, elevating costs of treatment. The initial benefit of endovascular surgery is lost during long follow up as survival curves become similar to those of open surgery. Even for patients wilt a high surgical risk, the benefits of endovascular surgery are doubtful (Rev Med Chile 2009; 137; 1081-8).
- ItemManejo endovascular de la isquemia crítica distal: análisis de una serie contemporánea(2020) Ignacio Torrealba, J.; Francisco Vargas, J.; Marine Massa, Leopoldo Ario Fernando; Bergoeing Reid, Michel Paul; Mertens Martín, Renato Alfonso; Valdés, Francisco J.Background: Chronic limb ischemia can lead to high rates of limb loss and mortality. Open surgery is the gold standard for treatment of distal disease. Endovascular surgery should have less complications with similar outcomes. Aim: To report a cohort of patients with distal arterial disease treated with endovascular surgery at our institution. Material and Methods: Review of angioplasty records of patients undergoing distal lower extremity endovascular procedures between 2016 and 2019. Demographics, comorbidities, form of presentation, type of intervention, perioperative complications, and length of stay were analyzed. The primary outcomes were wound healing, reinterventions and freedom from major amputation. Secondary outcomes were overall survival and amputation-free survival. Results: Forty-eight limbs of 41 patients with a mean age 75 years (78% males) were treated. Ninety-three percent had hypertension, 88% diabetes, 30% chronic kidney disease. 73% presented with major wounds. Plain balloon and drug coated balloon angioplasties were carried out in 65 and 31% of procedures respectively, with no difference in results. In 46% of the cases, only chronic total occlusions were treated. Wound healing was achieved in 85% of procedures and 90% of patients were free from amputation at one year of follow up. Complications were observed in 18% of procedures, perioperative mortality was 2% and one-year survival was 76%. Conclusions: Endovascular therapy achieves high rates of wound healing and freedom from amputation with low perioperative mortality and moderate complication rates.
- ItemSurgical Outcomes of Infective Native Aortoiliac Aneurysms in a Chilean Academic Center(ELSEVIER SCIENCE INC, 2024) Gonzalez Urquijo, Mauricio; Mertens Martin, Renato Alfonso; Vargas Serrano, José Francisco; Marine Massa, Leopoldo Ario Fernando; Bergoeing Reid, Michel Paul; Valdes, Francisco; Torrealba Fonck, José IgnacioBackground: Infective native aortic aneurysms (INAAs), formerly called mycotic aneurysms, remain an uncommon disease with significant heterogeneity among cases; hence, there is lack of solid evidence to opt for the best treatment strategy. The present study aims to describe a 20-year experience at a single institution treating this uncommon condition. Methods: Retrospective study of all patients treated for INAA at a single academic hospital in Santiago, Chile, between 2002 and 2022. Clinical characteristics are described, as well as operative outcomes per type of treatment. Nonparametric Mann-Whitney U-test or Kruskal-Wallis tests were performed when appropriate, and results were reported as median and ranges. Survival at given timeframes was determined by a Kaplan-Meier curve, with analysis performed through a Cox regression model. Results: During the study period, 1,798 patients underwent aortic procedures at our center, of which 35 (1.9%) were treated for INAA. Of them, 25 (71.4%) were male. One patient had 2 INAAs. Median age was 69.5 years (range: 34-89 years). Of the 36 INAAs, the most frequent location was the abdominal and thoracic aorta in 20 (55.5%) and 11 (30.5%) cases, respectively, followed by the iliac arteries in 4 (11.1%) cases. One (2.7%) patient presented a thoracoabdominal INAA. Overall, endovascular treatment associated with long-term antibiotics was used in 20 (57.1%) patients: 4 of them underwent hybrid treatment. Fifteen (42.8%) patients underwent direct aortic debridement followed by in situ or extra anatomic revascularization. There was a significant difference in age between both treatment strategies (a median of 76.5 years for endovascular versus a median of 57 years for open, P = 0.011). The median hospital stay was 15 days (range: 2-70 days). The early complications rate (<30 postoperative days) was 20% (n = 7). Early mortality rate (inhospital or before postoperative 30 days) was 14.2% (n = 5). Median follow-up was 33 months (range: 6-216 months). The overall survival rates at 1, 3, and 5 years were 69.9% (standard error [SE] 8.0), 61.7% (SE 9.8), and 50.9% (SE 11.8), respectively. Five-year survival rate of patients undergoing endovascular treatment compared with open approach was 45.9% (SE 15.1) versus 80.0% (SE 17.8), respectively (P = 0.431). There were no significant differences in survival between open and endovascular treatment, hazard ratio 3.58 (confidence interval 95%: 0.185-1.968, SE +/- 0.45 P = 0.454). Conclusions: Patients treated by endovascular approach were older than patients treated by open approach. Even though, the open group had a higher 5-year survival rate than the endovascular group, not statically significance differences were found between treatments.
- ItemTratamiento endovascular de transecciones agudas de la aorta descendente(2011) Marine Massa, Leopoldo Ario Fernando; Mertens Martin, Renato Alfonso; Valdés Echenique, José Francisco; Kramer Schumacher, Albrecht Helmuth; Bergoeing Reid, Michel Paul; Plaza De Los Reyes Z., Miguel; Fernández S., FroilánBackground: Traumatic rupture of the thoracic aorta as a result from high-speed deceleration injury is associated with a mortality rate of 80% to 90% at the scene of the accident. Survivors usually have life-threatening injuries to other organ systems. Standard open repair is associated with a high perioperative morbidity and mortality. Endografting offers a less invasive alternative to open surgical repair. Aim: To evaluate results of endovascular management of acute traumatic descending thoracic aortic ruptures. Methods: Between August 2002 and March 2010, patients treated for this trauma were reviewed. Results: 16 patients (fourteen males mean age 42.7 +/- 15.8 years, range 24-74) underwent endovascular treatment of an acute aortic rupture. Associated traumas in fifteen patients were: severe brain (7), spleen (4), liver (1), kidney (3) and large bone (9) injuries. Motor vehicle accidents caused 13 of the injuries and fall from height 3. Rupture was diagnosed with admission CT scan and confirmed by intraoperative angiogram. Patients were treated with thoracic aortic endograft, in 11 cases the left subclavian artery was covered with no need for further revascularization. Technical success was 100%, no procedure-related mortality or paraplegia was observed. One patient died 5 days after the procedure due to severe associated injuries. During a mean follow-up of 30.8 months (range 1-80), no deaths, complications or need for further interventions presented. Conclusion: Endovascular treatment of acute traumatic aortic isthmic rupture is encouraging and compares favorably to open surgical approach with low morbidity and mortality rates.
- ItemTumor del cuerpo carotídeo: A propósito de 10 casos tratados(2007) Soto González, Sebastián; Valdés Echenique, José Francisco; Kramer Schumacher, Albrecht Helmuth; Marine Massa, Leopoldo Ario Fernando; Bergoeing Reid, Michel Paul; Mertens Martin, Renato Alfonso; Solar González, Antonieta Alejandra; Walton Díaz, Annerleim Nylsello; Aguilera Vergara, Glenda JeannetteBackground: Carotid body tumors arise from a cellular conglomerate located at the carotid bifurcation. Progressive enlargement can involve the arterial wall and neighbor cranial nerves. Aim: To report a series of 10 patients treated of carotid body tumors and review national experience. Patients and methods: Between 1984 and 2006 we operated 8 women and 2 men. aged 19 to 75 years. with this type of tumor. Results. The most common cause for consultation was a cervical mass in 90%, with a mean evolution lapse of 13.2 months (range 3 to 126). In all cases, diagnosis wets confirmed with angiographic imaging and. histopathology. Ten tumors were surgically removed with no complications. Eighty percent of tumors were in stage II according to Shamblin classification. During long term follow tip all patients have remained asymptomatic. Only 31 carotid body tumors have been reported in Chilean medical literature during a 43 year period. Conclusions: Paragangliomas of the carotid body can be diagnosed in clinical grounds. requiring vascular imaging. These infrequent lesions are generally benign, early surgical removal by surgeons with vascular expertise avoids neurological and or vascular complications (Rev Med Chile 2007; 135: 1414-20).