Carlos Vaquero - Academia.edu (original) (raw)

Papers by Carlos Vaquero

Anesthesia & Analgesia, 2004

Recently, fenestrated, branched and stent grafts have been developed in order to treat endovascul... more Recently, fenestrated, branched and stent grafts have been developed in order to treat endovascular aneurysmal pathology at the level of the aorta in the emergence of the visceral arteries. For the implantation of stents, it is necessary to have a precise planimetry of the origin and orientation of the visceral branches in order firstly to perform the correct manufacture of the endoprosthesis and secondly the placement with precision of the same. The knowledge of the emergency of the vessels of the aortic wall and its orientation knowing the angle of emergency. The data obtained for the planning of the endovascular treatment of 37 patients in order to obtain data from the descriptive point of view of this sector

espanolLa angulacion en diferentes planos del cuello de los aneurismas de la aorta abdominal pued... more espanolLa angulacion en diferentes planos del cuello de los aneurismas de la aorta abdominal puede considerarse un factor limitante en la implantacion de diferentes protesis en el tratamiento de esta patologia. Es necesario realizar una valoracion de los angulos en diferentes planos en estudios rutinarios previos a la planificacion de los procedimientos y muy especialmente mediante AngioTAC. Se valora en el estudio la medicion de 507 pacientes portadores de aneurismas de aorta abdominal y tratados por metodos endovasculares y de los que se disponia la informacion completa a nivel de angulaciones del cuello. Se valoran en un estudio prospectivo y descriptivo la situacion de este sector aortico aportando informacion al respecto con respecto a la tendencia en la presentacion morfologica de la aorta en enfermos portadores de esta patologia. EnglishAngulation in different planes of the neck of abdominal aortic aneurysms may be considered a limiting factor in the implantation of different...

espanolLos objetivos de la terapia de extirpacion varicosa en pacientes con enfermedad venosa sin... more espanolLos objetivos de la terapia de extirpacion varicosa en pacientes con enfermedad venosa sintomatica son la mejoria en los sintomas, la apariencia y la prevencion de complicaciones. El tratamiento quirurgico de las venas superficiales varicosas produce efectos beneficiosos al reducir el volumen venoso en la extremidad y de ese modo los efectos nocivos de la hipertension venosa sobre los tejidos cutaneos. Los metodos quirurgicos de la ablacion de la vena en gran parte han sido sustituidos por metodos cada vez menos invasivos. Poco a poco se ha ido imponiendo las tecnicas endovasculares. La eficacia de las diferentes tecnicas no es la cuestion puesto que todas son eficaces si estan bien realizadas. La pregunta real es el costo y los resultados a corto plazo. EnglishThe goals of ablation therapy in patients with symptomatic venous disease are improvement in symptoms, appearance and prevention of complications. Superficial vein ablation produces beneficial effects by reducing venou...

Cirugía Española, 2016

Introduccio´n: Conocer la utilidad de las escalas de riesgo de mortalidad para el tratamiento end... more Introduccio´n: Conocer la utilidad de las escalas de riesgo de mortalidad para el tratamiento endovascular de los pacientes con aneurisma de aorta abdominal roto. Diseñ ar una escala de riesgo específica. Me´todos: Estudio retrospectivo de 61 pacientes intervenidos mediante reparació n endovascular de aneurisma de aorta abdominal roto entre 2009 y 2014. Se recogieron variables preoperatorias y de mortalidad intrahospitalaria, así como las escalas Hardman, GAS, Vancouver y ERAS. Resultados: La mortalidad intrahospitalaria fue del 45,9%. El estudio univariante obtuvo como factores pronó sticos la edad, el sexo varó n, la hipertensió n arterial, el há bito tabáquico, la enfermedad pulmonar obstructiva cró nica, la tensió n arterial sistó lica < 90 mmHg, la frecuencia cardiaca y la pé rdida de conciencia. Tras la realizació n del aná lisis multivariante, la variables significativas fueron la edad (p = 0,021), la presió n arterial sistó lica (p = 0,004) y la frecuencia cardiaca (p = 0,050). Las escalas GAS (76,79 AE 9,88 vs. 90,43 AE 14,76; p = 0,001), Vancouver (4,41 AE 0,62 vs. 4,83 AE 0,55; p = 0,007) y ERAS (0,06 AE 0,24 vs. 0,86 AE 0,76; p = 0,001) resultaron estadísticamente diferentes en los pacientes fallecidos. La escala resultante de la siguiente fó rmula: 0,083 + 0,158 (si edad > 80 añ os) + 0,701 (si tensió n arterial< 80 mmHg) + 0,598 (si frecuencia cardiaca< 70 lat/min) obtuvo un á rea bajo la curva de 0,95. Conclusiones: Edad, presió n sistó lica y frecuencia cardiaca constituyen factores predictores de mortalidad intrahospitalaria de los pacientes con aneurisma de aorta abdominal roto tratados mediante exclusió n endovascular. La aplicació n de la escala propuesta en el presente estudio, en combinació n con las escalas GAS, Vancouver y ERAS, permite conocer los pacientes que no se beneficiarían de tratamiento endovascular.

Ingenieria Mecanica, Apr 1, 2011

Recibido el 26 de octubre de 2010; aceptado el 23 de diciembre de 2010 Resumen La ruptura de los ... more Recibido el 26 de octubre de 2010; aceptado el 23 de diciembre de 2010 Resumen La ruptura de los aneurismas de aorta abdominal representa un evento clínico muy importante debido a su alta tasa de mortalidad. Los indicadores empleados actualmente para decidir el tratamiento a pacientes con aneurismas son el diámetro máximo transversal y la tasa de crecimiento, los que pueden ser considerados insuficientes, pues no tienen una base teórica físicamente fundamentada. En el presente artículo se definen los fundamentos para el diseño de una herramienta informática para PC que permita predecir, con suficiente precisión para ser clínicamente relevante, el riesgo de ruptura de aneurismas de aorta abdominal sobre bases personalizadas del paciente. La herramienta consta de 3 módulos, que están diseñados para procesar toda la información del paciente e integrarla mediante un modelo que incorpora la interrelación de los factores biomecánicos de diferentes naturalezas (biológicos, estructurales y geométrico) y escalas (temporal y dimensional), con el objetivo de calcular un indicador numérico y personalizado del riesgo de ruptura. Esta herramienta debe constituir un elemento auxiliar del facultativo médico en la toma de decisiones respecto del tratamiento adecuado a pacientes con aneurisma. Palabras claves: AAA, riesgo de ruptura, modelo multiescala, predicción, herramienta informática.

Diagnosis and Treatment of Abdominal and Thoracic Aortic Aneurysms Including the Ascending Aorta and the Aortic Arch, 2011

Interactive cardiovascular and thoracic surgery, 2014

Ischaemia-reperfusion (I/R) injury is encountered in conditions that diminish intestinal blood fl... more Ischaemia-reperfusion (I/R) injury is encountered in conditions that diminish intestinal blood flow. There is no clinically feasible technique available for mucosal preservation. One hundred Wistar rats were subjected to intestinal ischaemia for 15 and 60 min (I15', I60'), followed by 1 and 7 days of reperfusion (R1d, R7d). Rats were subjected to ischaemia by clamping the superior mesenteric artery. Prostaglandin E1 (PGE1) (2.500 ng/kg intra-arterial bolus or 20 ng/kg intravenous infusion) was administered immediately prior to the commencement of the experimental period. Animals were divided into 20 groups: sham (laparotomy alone), sacrificed at 1 or 7 days; saline administration, 15 or 60 min of ischaemia, 1 or 7 days of reperfusion; prostaglandin E1 administration, 15 or 60 min of ischaemia, 1 or 7 days of reperfusion, each one for intra-arterial or intravenous administration. Ileal segments were excised and assessed for histopathological score, polymorphonuclear (PMN) leu...

Revista Internacional de Métodos Numéricos para Cálculo y Diseño en Ingeniería, 2015

Interactive CardioVascular and Thoracic Surgery, 2008

Objectives: To analyze the postoperative complications of patients who have undergone surgical re... more Objectives: To analyze the postoperative complications of patients who have undergone surgical repair of femoral pseudoaneurysm after cardiac catheterization. Design: Prospective study. Materials: Cardiovascular risk factors, related to surgery and cardiac catheterization were collected prospectively in 79 patients from 2003 to 2006 in Valladolid University Hospital. The indications of surgery included necrosis of adjacent soft tissue, rapid growth, infection, bleeding, hemodynamic instability or failure of the percutaneous treatment (US-guided compression and US-guided percutaneous thrombin injection). Methods: Patient and management related predictors for 30-day outcome were analyzed. Results: Fifty-six patients (56y79, 71%) experienced some type of postoperative complication, the most frequent being the need for a transfusion. Infection (15y79, 19%) and dehiscence of the surgical wound (10y79, 12.7%) were the other two most common complications. The mortality related to the intervention was 3.8% (3y79). The mean hospital stay was 32.5 days ("28.4 days). Significant risk factors in logistic regression model were gender (Ps0.023, ORs9.66), 70 years old (Ps0.049, ORs0.15) and the concurrent use of anticoagulation or antiplatelet therapy after the cardiac catheterization (Ps0.005, ORs0.03). Conclusion: Patients who undergo surgical treatment of femoral pseudoaneurysm post-cardiac catheterization experience a high postoperative morbidity and hospital stay. Factors such as female gender, age over 70 years and treatment with anticoagulants or antiplatelets increase the postoperative morbidity. A seasonal influence was appreciated, with a higher frequency during the summer period.

Journal of vascular and interventional radiology : JVIR, 2015

Annals of Vascular Surgery, 2012

Revista Española de Cardiología, 2011

Introduccio´n y objetivos: Evaluar legibilidad, accesibilidad, utilidad y fiabilidad de la inform... more Introduccio´n y objetivos: Evaluar legibilidad, accesibilidad, utilidad y fiabilidad de la informació n existente en internet sobre el aneurisma de aorta y su tratamiento endovascular, para comprobar su funció n como vehículo de informació n comprensible que capacite al paciente para participar en decisiones respecto a su enfermedad. Me´todos: En noviembre de 2010 se recopiló informació n en internet sobre los té rminos «aneurisma aorta» y «endopró tesis de aorta» empleando los buscadores má s extendidos: Google, Yahoo y MSN/Bing. Se analizaron las primeras 30 pá ginas ofrecidas por cada uno. Para calcular la legibilidad de los textos, se empleó el programa informá tico Inflesz y el instrumento LIDA como mé todo validado de evaluació n de pá ginas web relacionadas con la salud sobre accesibilidad, utilidad y fiabilidad.

Aneurysm, 2012

This new approach has its foundation in the integration, through appropriate relations, of factor... more This new approach has its foundation in the integration, through appropriate relations, of factors from different natures (biological, structural and geometric) and scales (temporal and dimensional) at the molecular, cellular, tissue and organ levels (from bottom level to top level), which allow to describe, from quantitatively point of view, the aneurysm progression and its rupture potential. These defined relations are known as biomechanical factors or biomechanical determinants (BDs). The basic premise of the biomechanical approach to estimate the AAA rupture risk, is that this phenomenon follows the principle of material failure, that is, an aneurysm ruptures when the stresses acting on the arterial wall exceeding its failure strength, reflecting the interaction between the arterial wall structural remodelling and the forces generated by blood flow within the AAA.

Biomedical Engineering, 2011

Journal of Vascular Surgery, 1999

The primary objective of this study was to evaluate with venography the rate of thrombus regressi... more The primary objective of this study was to evaluate with venography the rate of thrombus regression after a fixed dose of low-molecular weight heparin (LMWH) per day for 3 months compared with oral anticoagulant therapy for deep venous thrombosis (DVT). Secondary endpoints were the comparisons of the efficacy and safety of both treatments. Methods: This study was designed as an open randomized clinical study in a university hospital setting. Of the 165 patients finally enrolled in the study, 85 were assigned LMWH therapy and 80 were assigned oral anticoagulant therapy. In the group randomized to oral anticoagulant therapy, the patients first underwent treatment in the hospital with standard unfractionated heparin and then coumarin for 3 months. Doses were adjusted with laboratory monitoring to maintain the international normalized ratio between 2.0 and 3.0. Patients in the LMWH group were administered subcutaneous injections of fixed doses of 40 mg enoxaparin (4000 anti-Xa units) every 12 hours for 7 days, and after discharge from the hospital, they were administered 40 mg enoxaparin once daily at fixed doses for 3 months without a laboratory control assay. A quantitative venographic score (Marder score) was used to assess the extent of the venous thrombosis, with 0 points indicating no DVT and 40 points indicating total occlusion of all deep veins. The rate of thrombus reduction was defined as the difference in quantitative venographic scores after termination of LMWH or coumarin therapy as compared with the scores obtained on the initial venographic results. The efficacy was defined as the ability to prevent symptomatic extension or recurrence of venous thromboembolism (documented with venograms or serial lung scans). The safety was defined as the occurrence of hemorrhages. Results: After 3 months of treatment, the mean Marder score was significantly decreased in both groups in comparison with the baseline score, although the effect of therapy was significantly better after LMWH therapy (49.4% reduction) than after coumarin therapy (24.5% reduction; P < .001). LMWH therapy and male gender were independently associated with an enhanced resolution of the thrombus. A lower frequency of symptomatic recurrent venous thromboembolism was also shown in patients who underwent treatment with LMWH therapy (9.5%) than with oral anticoagulant therapy (23.7%; P < .05), although this difference was entirely a result of recurrence of DVT. Bleeding complications were significantly fewer in the LMWH group than in the coumarin group (1.1% vs 10%; P < .05). This difference was caused by minor hemorrhages. Coumarin therapy and cancer were independently associated with an enhanced risk of complications. Subcutaneous heparin therapy was well tolerated by all patients. Conclusion: The patients who were allocated to undergo enoxaparin therapy had a significantly greater improvement in their quantitative venographic score, a significantly 283

Journal of Vascular Surgery, 1996

The efficacy of epidural regional hypothermia in the prevention of acute and delayed-onset parapl... more The efficacy of epidural regional hypothermia in the prevention of acute and delayed-onset paraplegia, as well as possible complications and limitations of this technique to a clinically acceptable form, were evaluated in 49 New Zealand white rabbits. Methods: A modified rabbit spinal cord ischemia model of infrarenal aortic occlusion for 30 minutes was employed. The study was performed in two phases. In phase I (n = 20), regional hypothermia induced by epidural perfusion of iced normal saline solution (4 ~ C) was tested versus control in 10 rabbits each (groups A and B). In phase II (n = 29) the animals were subdivided into three groups to study the kinetics of absorption and distribution of methylene blue (group C; n = 10), radiographic contrast material (group D; n = 9), and measurement ofcerebrospinal pressure while an epidural iced solution was or was not infused (group E; n = 10). Results: At 24 and 48 hours, all of the normothermic animals showed irreversible paraplegia (Tarlov score 0). In contrast, at 24 hours none of the rabbits undergoing epidural cold infusion were paraplegic, although at 48 hours one animal had weakness of a hindiimb (Tarlov score 3). Plasma concentration-time profiles of a continuous epidural perfusion with methylene blue showed that the spinal canal is a highly compliant space. Epidurographs showed that epidural perfusion tends to spread more in a cephalic than caudal direction and the main uptake is by the vascular compartiiient. Despite the large volumes infused (78.75 ml/hr; range, 50 to 100 ml), we observed only a modest transient increase in cerebrospinal fluid pressure (from 2.5-+ 0.3 mm Hg to 5.4-+ 0.1 mm Hg), although some animals had intracranial hypertension. Conclusions: Regional hypothermia induced by epidural cold perfusion has a highly protective effect against the ischemic spinal cord damage. However, this method probably does not avoid the risk of delayed-onset paraplegia. An important limitation of this technique is the difficulty of controlling the intrathecal pressures. (J VAsc SURG 1996;23:446-52.) The most devastating and unpredictable complication after surgery of the descending and thoracoabdominal aorta is paraplegia. This complication ranges from 0.5% to 38%, ~ depending on factors such as the type and extent of reconstruction, the presence of

Journal of Vascular Surgery, 2013

A 33-year-old hypertensive woman who was a heavy smoker presented in 1982 with a history of pain ... more A 33-year-old hypertensive woman who was a heavy smoker presented in 1982 with a history of pain in her buttocks and thighs after walking 300 meters; her right leg was more severely affected. Clinical examination revealed absent femoral, popliteal, and pedal pulses in both legs. No bruits were audible in the abdomen or groins. Ankle-brachial pressure index was 0.50 in the left limb and 0.55 in the right. Laboratory findings and results of hematologic tests were normal, except for low-density lipoprotein hypercholesterolemia. Other etiologies, such as Takayasu disease, fibromuscular dysplasia, and hypoplastic aorta syndrome, were considered. Angiography revealed total occlusion of the infrarenal aorta, with both common iliac arteries severely affected. The patient refused surgical treatment. Medical treatment included oral antiplatelet, pentoxifylline, and statin therapy. The patient also initiated a walking regimen. After 30 years, the patient started complaining when walking distances >500 meters. Anklebrachial pressure index had increased to 0.67 bilaterally. The patient underwent arterial contrastenhanced computed tomographic scanning (A). In this case, collateral pathways include both visceral (B) and parietal (C and D) routes, such as internal mammary to inferior epigastric, intercostals to circumflex iliac, lumbar and hypogastric to common femoral, superior mesenteric to inferior mesenteric, and superior hemorrhoidal pathways via the marginal artery of Drummond and arc of Riolan. Visceral-systemic pathways are shown in B. The meandering mesenteric artery (of Riolan) hypertrophied, collateral between the superior and inferior mesenteric circulations (white arrow). Systemic-systemic pathways are shown in C. The intercostal arteries communicate with the external iliac artery through a network of lumbar and iliolumbar arteries (white arrows). The internal thoracic arteries communicate with the inferior epigastric arteries (yellow arrows). A lateral projection of the systemic-systemic collateral pathways is shown in D. The diameter of the inferior epigastric arteries was the same as the superficial femoral arteries.

Journal of Vascular Surgery, 2012

A 61-year-old woman with a history of left dorso-lumbar scoliosis and severe dorso-lumbar kyphosi... more A 61-year-old woman with a history of left dorso-lumbar scoliosis and severe dorso-lumbar kyphosis underwent surgical treatment of a spinal deformity. Surgery was conducted on the patient by performing a dorso-lumbar spinal arthrodesis (T6-L5) by means of the insertion of two longitudinal rods and a number of pedicle-expander screws at different vertebral levels. Following the orthopedic surgery, the patient presented paraparesis of the lower limbs and anemia that required transfusion. In the immediate postoperative period, a noncontrast-enhanced computed tomography (CT) scan was obtained to assess the medullary canal. A deviation of the left screw placed at T6 was detected; this screw projected outward from the vertebral cortex, protruding into the descending thoracic aorta. A contrast-enhanced CT scan showed that the screw had been malpositioned, and the image was highly suggestive of a perforation of the aortic wall, despite a lack of evidence of a peri-aortic hematoma, extravasation of contrast medium, or pleural effusion. The patient remained hemodynamically stable, and the decision was to perform an endovascular repair electively within 24 hours (A, Cover). In the operating room, a transesophageal echocardiogram (TEE) showed a metal object in the uppermost portion of the descending aorta constricting the arterial wall and giving rise to a tent-shaped image. A turbulent flow beneath the arterial intima and an intramural hematoma without active bleeding were found at that level (B). The patient was placed in a right decubitus position in the operating room to simultaneously perform the endovascular surgery of the thoracic aorta and the removal of the screw by the orthopedic surgeon. A single 28-ϫ 28-ϫ 100-mm Medtronic Valiant (Medtronic, Santa Rosa, Calif) thoracic endoprosthesis was introduced through the left common femoral artery into the proximal descending thoracic aorta at the site of injury. Afterward, an orthopedic surgeon manually removed the screw placed at D6, and the endograft was then expanded with a Reliant Stent Graft Balloon Catheter (Medtronic). There was no evidence of any leakage or signs of bleeding by TEE and intraoperative angiographic control. During the postoperative period, the patient recovered lower limb strength and mobility, and she was discharged uneventfully within 72 hours. A follow-up contrastenhanced CT scan that did not show signs of complications was obtained 1 month after the repair (C).