Browsing by Author "Torrealba Fonck, José Ignacio"
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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.
- ItemConcentración de la cirugía de aneurisma de aorta abdominal roto en centros especializados calificados(2022) Mariné Massa, Leopoldo Ario Fernando; Mertens Martin, Renato Alfonso; Valdés Echenique, José Francisco; Torrealba Fonck, José Ignacio; Bergoeing Reid, Michel Paul; Vargas Serrano, José Francisco; Villarroel, RicardoRuptured abdominal aortic aneurysm (RAAA) is an arterial emergency with an overall mortality of 80%-90% secondary to massive hemorrhage. If a patient with RAAA presents in a primary hospital without resolution capacity, survival will depend on early transfer to a center with adequately trained specialists. This article reviews the evidence supporting the centralization of AAAR treatment in qualified centers, specifying the criteria used for the selection of referral centers and the role of a coordinating unit. Our current referral system, which is based primarily on costs, is also described. Patients with AAAR who consult in non-resolving centers should be rapidly transferred to a qualified referral center, following a transfer protocol, and guided by a coordinating unit acting according to technical and established criteria based on results, quality, and costs. Qualified referral centers should have an accredited vascular surgeon and a high institutional aortic surgery volume, adequate infrastructure, endovascular resolution capacity, support services (intensive care, hemodialysis, etc.) and specialized personnel permanently available.
- ItemEndovascular management of a ruptured Iliac aneurysm with an inferior vena cava fistula(2020) Torrealba Fonck, José Ignacio; Vargas Serrano, José Francisco; Mertens Martín, Renato; Valdés, F. J.; Mariné M., Leopoldo; Bergoeing Reid, Michel Paul
- ItemEndovascular repair of bilateral internal mammary artery aneurysms in a patient with Marfan syndrome(2020) Mertens Martín, Renato; Velásquez, F. A.; Vargas, J. F.; Bergoeing Reid, Michel Paul; Mariné M., Leopoldo; Torrealba Fonck, José Ignacio
- ItemManagement of Carotid Bifurcation Tumors : 30-Year Experience(2016) Torrealba Fonck, José Ignacio; Valdés Echeñique, José Francisco; Kramer, Albrecht; Mertens Martín, Renato; Bergoeing Reid, Michel Paul; Mariné M., Leopoldo
- ItemOpen Surgery for Ruptured Abdominal Aortic Aneurysm-38 Years Experience at an Academic Center in Chile(2020) Mariné M., Leopoldo; Valdés Echeñique, José Francisco; Mertens Martín, Renato; Kramer, Albrecht; Vargas Rojas, Francisco Ignacio; Bergoeing Reid, Michel Paul; Torrealba Fonck, José Ignacio; Urbina, Jesús
- 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.
- ItemTelemedicina en cirugía vascular y endovascular: experiencia en un centro universitario(2022) Morales Palma, Álvaro José; Torrealba Fonck, José Ignacio; Bergoeing Reid, Michel Paul; Mariné M., Leopoldo; Mertens Martin, Renato; Valdés Echeñique, José Francisco; Vargas Serrano, José FranciscoBackground: Telemedicine became a relevant means to provide healthcare without face-to-face medical evaluation during the COVID-19 pandemic. Aim: To describe the effectiveness of telemedicine in vascular surgery. Materials and Methods: Review of medical records of all vascular surgery consultations carried out in a clinical hospital between April and October 2020. The main outcome measured was the resolution of the reason for consultation. Secondary outcomes were the need to request laboratory tests or imaging, the need to evaluate the patient in person, and the need for referral to hospitalization or emergency service. Results: One hundred-six new consultations and their follow-up (remotely or in person) were analyzed. A definitive diagnosis could be reached in 74% of consultations, treatment could be instituted or modified in 69% of them, and the reason for consultation could be resolved in 74% of cases. Laboratory and imaging tests were requested in 36 and 63% of consultations, respectively. Four percent of patients were referred to the emergency department or hospitalization. Conclusions: In the vast majority of consultations, it was possible to achieve a definitive diagnosis, prescribe a treatment and resolve the reason for consultation without the need for a face-to-face medical evaluation.
- ItemTwo Cases of Popliteal Cystic Adventitial Disease Treated with Primary Stenting: Long-Term Results(2020) Mertens, R.; Bergoeing Reid, Michel Paul; Mariné M., Leopoldo; Vargas Rojas, Francisco Ignacio; Torrealba Fonck, José Ignacio; Valdés Echeñique, José Francisco