93 results on '"Cairols, M"'
Search Results
52. New advances in the study of ischaemic patients
- Author
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Paaske, W.P. and Cairols, M.
- Published
- 2002
53. Continuing medical education in Europe. The impact of endovascular surgery
- Author
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Paaske, W.P. and Cairols, M.
- Published
- 2000
54. Results of the randomized, placebo-controlled clopidogrel and acetylsalicylic acid in bypass surgery for peripheral arterial disease (CASPAR) trial
- Author
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Jill J F, Belch, John, Dormandy, G M, Biasi, B M, Biasi, M, Cairols, C, Diehm, B, Eikelboom, J, Golledge, A, Jawien, M, Lepäntalo, L, Norgren, W R, Hiatt, J P, Becquemin, D, Bergqvist, D, Clement, I, Baumgartner, E, Minar, P, Stonebridge, F, Vermassen, L, Matyas, A, Leizorovicz, Evaluation et modélisation des effets thérapeutiques, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Belch, J, Dormandy, J, Biasi, G, Biasi, B, Cairols, M, Diehm, C, Eikelboom, B, Golledge, J, Jawien, A, Lepäntalo, M, Norgren, L, Hiatt, W, Becquemin, J, Bergqvist, D, Clement, D, Baumgartner, I, Minar, E, Stonebridge, P, Vermassen, F, Matyas, L, and Leizorovicz, A
- Subjects
Male ,Time Factors ,[SDV]Life Sciences [q-bio] ,Vein ,Kaplan-Meier Estimate ,law.invention ,Randomized controlled trial ,Risk Factors ,law ,Prospective Studies ,Amputation ,ComputingMilieux_MISCELLANEOUS ,Peripheral Vascular Diseases ,Aspirin ,education.field_of_study ,Graft Occlusion, Vascular ,Middle Aged ,Clopidogrel ,Europe ,surgical procedures, operative ,Treatment Outcome ,Bypass surgery ,Lower Extremity ,Anesthesia ,Platelet aggregation inhibitor ,Drug Therapy, Combination ,Female ,Cardiology and Cardiovascular Medicine ,circulatory and respiratory physiology ,medicine.drug ,Human ,Reoperation ,medicine.medical_specialty ,Ticlopidine ,Time Factor ,Population ,Hemorrhage ,Placebo ,Risk Assessment ,Amputation, Surgical ,Veins ,Blood Vessel Prosthesis Implantation ,Double-Blind Method ,medicine ,Humans ,cardiovascular diseases ,education ,Vascular Patency ,Proportional Hazards Models ,Aged ,Chi-Square Distribution ,business.industry ,Platelet Aggregation Inhibitor ,Risk Factor ,Australia ,Placebo Effect ,Surgery ,Prospective Studie ,Peripheral Vascular Disease ,Proportional Hazards Model ,business ,Platelet Aggregation Inhibitors - Abstract
International audience; Objective: Dual antiplatelet therapy with clopidogrel plus acetylsalicylic acid (ASA) is superior to ASA alone in patients with acute coronary syndromes and in those undergoing percutaneous coronary intervention. We sought to determine whether clopidogrel plus ASA conferred benefit on limb outcomes over ASA alone in patients undergoing below-knee bypass grafting.Methods: Patients undergoing unilateral, below-knee bypass graft for atherosclerotic peripheral arterial disease (PAD) were enrolled 2 to 4 days after surgery and were randomly assigned to clopidogrel 75 mg/day plus ASA 75 to 100 mg/day or placebo plus ASA 75 to 100 mg/day for 6 to 24 months. The primary efficacy endpoint was a composite of index-graft occlusion or revascularization, above-ankle amputation of the affected limb, or death. The primary safety endpoint was severe bleeding (Global Utilization of Streptokinase and Tissue plasminogen activator for Occluded coronary arteries [GUSTO] classification).Results: In the overall population, the primary endpoint occurred in 149 of 425 patients in the clopidogrel group vs 151 of 426 patients in the placebo (plus ASA) group (hazard ratio [FIR], 0.98; 95% confidence interval [CI], 0.78-1.23). In a prespecified subgroup analysis, the primary endpoint was significantly reduced by clopidogrel in prosthetic graft patients (HR, 0.65; 95% CI, 0.45-0.95; P = .025) but not in venous graft patients (HR, 1.25; 95% CI, 0.94-1.67, not significant [NS]). A significant statistical interaction between treatment effect and graft type was observed (P-interaction =.008). Although total bleeds were more frequent with clopidogrel, there was no significant difference between the rates of severe bleeding in the clopidogrel and placebo (plus ASA) groups (2.1% vs 1.2%).Conclusion: The combination of clopidogrel plus ASA did not improve limb or systemic outcomes in the overall population of PAD patients requiring below-knee bypass grafting. Subgroup analysis suggests that clopidogrel plus ASA confers benefit in patients receiving prosthetic grafts without significantly increasing major bleeding risk.
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- 2010
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55. EVAR Surveillance: An Ongoing Dilemma or Time to Face the Hard Truth?
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Grima MJ and Cairols M
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- Humans, Longitudinal Studies, Treatment Outcome, Aortic Aneurysm, Abdominal diagnostic imaging, Aortic Aneurysm, Abdominal surgery, Blood Vessel Prosthesis Implantation adverse effects, Endovascular Procedures adverse effects
- Published
- 2023
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56. Direct health costs and clinical outcomes of open surgery in patients with abdominal aortic aneurysm in Spain. The RECAPTA study.
- Author
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Egea M, Fernández-Samos R, Lechón JA, Reparaz L, Álvarez M, and Cairols M
- Subjects
- Aged, Aged, 80 and over, Aortic Aneurysm, Abdominal economics, Follow-Up Studies, Humans, Length of Stay, Male, Middle Aged, Postoperative Complications economics, Retrospective Studies, Spain, Aortic Aneurysm, Abdominal surgery, Health Care Costs statistics & numerical data, Postoperative Complications epidemiology
- Abstract
Objective: Abdominal aortic aneurysm (AAA) is a chronic, progressive disease that often requires surgical repair. This study aimed to assess the healthcare costs and clinical outcomes of open AAA repair in Spain., Method: Observational, retrospective, multicenter study with a one-year follow-up. Healthcare resource use and costs related to the surgical procedure, hospital stay, and follow-up period were assessed., Results: Ninety patients with asymptomatic AAA who underwent open repair were recruited between 2003 and 2009 at three Spanish hospitals. Four patients (4.44%) died in the first 30 postoperative days. Mean [standard deviation] procedure time was 292.83 [72.10] minutes and mean hospital length of stay was 11.44 days [5.42]. Thirty two patients (35.56%) presented in-hospital complications and three patients (3.45%) underwent re-intervention during follow-up. The mean overall cost per patient during the study period was €21,622.59, of which 42.40% (€9,168.19), 52.08% (€11,261.74), and 5.52% (€1,192.66) corresponded to the surgical procedure, the inpatient stay, and the study follow-up period, respectively., Conclusions: Given the economic burden imposed by the treatment of patients admitted with AAA on the Spanish health system, additional efforts comparing the cost of open repair with endovascular treatments are needed to ensure greater efficiency.
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- 2018
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57. Intervention Should not be the Thermopylae to Avoid Amputation: Commentary on "Not All Patients with Critical Limb Ischaemia Require Revascularisation".
- Author
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Cairols MA
- Subjects
- Humans, Ischemia surgery, Leg blood supply, Treatment Outcome, Amputation, Surgical, Vascular Surgical Procedures
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- 2017
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58. [Clinical characteristics and in-hospital outcomes of patients with critical leg ischemia: ICEBERG Study].
- Author
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Mostaza JM, Puras E, Álvarez J, Cairols M, García-Rospide V, Miralles M, Escudero JR, and Arroyo Bielsa A
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- Adult, Aged, Critical Illness, Female, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Treatment Outcome, Ischemia diagnosis, Ischemia mortality, Ischemia therapy, Leg blood supply
- Abstract
Background and Objectives: Critical leg ischemia (CLI) is a medical emergency with a high morbidity and mortality. Although its prognosis has improved during the last years, there are no data on its clinical characteristics, treatment and in-hospital prognosis in our country., Patients and Method: 671 patients (81% males, mean age 71.2 years) with atherosclerotic CLI, attended in 46 departments of vascular surgery were included in the study., Results: Participants had a high prevalence of cardiovascular risk factors (72% hypertensive, 27% current smokers, 59% diabetics) and comorbidity (25% coronary heart disease, 18% cerebrovascular disease). 71% had a previous diagnosis of peripheral arterial disease. Upon admission, 71% were referred for revascularization, 5% for direct amputation and 24% for conservative treatment. During hospitalization 22 patients died and 49 were discharged with a major amputation. On multivariate analysis, the only factor associated with the risk of amputation was gangrenous lesions (OR 2.45; IC95% 1.22-4.92). Factors associated with mortality were the presence of chronic renal failure (OR 3.38; IC95% 1.36-8.39) and previous CLI (OR 0.20; IC95% 0.05-0.89). At discharge, 59% received lipid lowering drugs, 70% blood-pressure lowering medications and 85% antiplatelet drugs., Conclusion: CLI patients attended in Spanish vascular surgery departments have a low amputation rate and a low hospital mortality. However, and due to their high cardiovascular risk, it is necessary to improve the prescription rate of evidence-based cardiovascular prevention therapies at discharge., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)
- Published
- 2011
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59. The role of the UEMS vascular surgery in Europe.
- Author
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Cairols MA
- Subjects
- Certification, Clinical Competence, Curriculum, Europe, Humans, Education, Medical, Graduate, Endovascular Procedures education, Internship and Residency, Societies, Medical, Vascular Surgical Procedures education
- Published
- 2011
60. Results of the randomized, placebo-controlled clopidogrel and acetylsalicylic acid in bypass surgery for peripheral arterial disease (CASPAR) trial.
- Author
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Belch JJ, Dormandy J, Biasi GM, Cairols M, Diehm C, Eikelboom B, Golledge J, Jawien A, Lepäntalo M, Norgren L, Hiatt WR, Becquemin JP, Bergqvist D, Clement D, Baumgartner I, Minar E, Stonebridge P, Vermassen F, Matyas L, and Leizorovicz A
- Subjects
- Aged, Amputation, Surgical, Aspirin adverse effects, Australia, Chi-Square Distribution, Clopidogrel, Double-Blind Method, Drug Therapy, Combination, Europe, Female, Graft Occlusion, Vascular etiology, Graft Occlusion, Vascular prevention & control, Hemorrhage chemically induced, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Peripheral Vascular Diseases mortality, Peripheral Vascular Diseases physiopathology, Placebo Effect, Platelet Aggregation Inhibitors adverse effects, Proportional Hazards Models, Prospective Studies, Reoperation, Risk Assessment, Risk Factors, Ticlopidine adverse effects, Ticlopidine therapeutic use, Time Factors, Treatment Outcome, Vascular Patency, Aspirin therapeutic use, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation mortality, Lower Extremity blood supply, Peripheral Vascular Diseases surgery, Platelet Aggregation Inhibitors therapeutic use, Ticlopidine analogs & derivatives, Veins transplantation
- Abstract
Objective: Dual antiplatelet therapy with clopidogrel plus acetylsalicylic acid (ASA) is superior to ASA alone in patients with acute coronary syndromes and in those undergoing percutaneous coronary intervention. We sought to determine whether clopidogrel plus ASA conferred benefit on limb outcomes over ASA alone in patients undergoing below-knee bypass grafting., Methods: Patients undergoing unilateral, below-knee bypass graft for atherosclerotic peripheral arterial disease (PAD) were enrolled 2 to 4 days after surgery and were randomly assigned to clopidogrel 75 mg/day plus ASA 75 to 100 mg/day or placebo plus ASA 75 to 100 mg/day for 6 to 24 months. The primary efficacy endpoint was a composite of index-graft occlusion or revascularization, above-ankle amputation of the affected limb, or death. The primary safety endpoint was severe bleeding (Global Utilization of Streptokinase and Tissue plasminogen activator for Occluded coronary arteries [GUSTO] classification)., Results: In the overall population, the primary endpoint occurred in 149 of 425 patients in the clopidogrel group vs 151 of 426 patients in the placebo (plus ASA) group (hazard ratio [HR], 0.98; 95% confidence interval [CI], 0.78-1.23). In a prespecified subgroup analysis, the primary endpoint was significantly reduced by clopidogrel in prosthetic graft patients (HR, 0.65; 95% CI, 0.45-0.95; P = .025) but not in venous graft patients (HR, 1.25; 95% CI, 0.94-1.67, not significant [NS]). A significant statistical interaction between treatment effect and graft type was observed (P(interaction) = .008). Although total bleeds were more frequent with clopidogrel, there was no significant difference between the rates of severe bleeding in the clopidogrel and placebo (plus ASA) groups (2.1% vs 1.2%)., Conclusion: The combination of clopidogrel plus ASA did not improve limb or systemic outcomes in the overall population of PAD patients requiring below-knee bypass grafting. Subgroup analysis suggests that clopidogrel plus ASA confers benefit in patients receiving prosthetic grafts without significantly increasing major bleeding risk., (Copyright © 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)
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- 2010
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61. [New oral anticoagulants: a multidisciplinary approach].
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Arcelus JI, Cairols M, Granero X, Jiménez D, Vicente Llau J, Monreal M, and Vicente V
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- Administration, Oral, Humans, Interdisciplinary Communication, Anticoagulants administration & dosage
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- 2009
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62. Guidelines for the organisation of vascular centres in Europe. Part I.
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Benedetti-Valentini F, Diamantopoulos E, Antignani PL, Bastounis E, Carpentier P, Fernandes e Fernandes J, Nicolaides A, Bergqvist D, Cairols M, Liapis CD, Nevelsteen A, and Van Bockel JH
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- Cooperative Behavior, Diagnostic Imaging, Education, Medical, Graduate, Europe, Facility Design and Construction, Health Facilities standards, Humans, Interdisciplinary Communication, Patient Care Team organization & administration, Quality Indicators, Health Care, Radiography, Interventional, Vascular Diseases diagnosis, Vascular Diseases surgery, Vascular Surgical Procedures education, Vascular Surgical Procedures standards, Health Facility Administration, Organizational Objectives, Vascular Diseases therapy, Vascular Surgical Procedures organization & administration
- Published
- 2009
63. Thigh and buttock exertional pain for the diagnosis of peripheral arterial disease.
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Manzano L, García-Díaz Jde D, Suárez C, Mostaza JM, Cairols M, González-Sarmiento E, Rojas AM, Vieitez P, Sánchez-Zamorano MA, and Zamora J
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- Aged, Algorithms, Buttocks, Cross-Sectional Studies, Female, Humans, Intermittent Claudication diagnosis, Intermittent Claudication epidemiology, Male, Middle Aged, Predictive Value of Tests, Prevalence, Risk Factors, Sensitivity and Specificity, Thigh, Pain diagnosis, Pain epidemiology, Peripheral Vascular Diseases diagnosis, Peripheral Vascular Diseases epidemiology, Surveys and Questionnaires
- Abstract
Objectives: To evaluate the prevalence of both non-calf intermittent claudication (IC) and classic IC in patients with no known atherosclerotic disease, and their accuracy to detect peripheral arterial disease (PAD)., Design: Cross sectional, observational study conducted at 96 internal medicine services., Materials and Methods: 1487 outpatients with no known atherosclerotic disease, and either diabetes or a SCORE risk estimation of at least 3% were enrolled. IC was assessed using the Edinburgh Claudication Questionnaire and PAD was confirmed by an ankle-brachial index (ABI) <0.9., Results: Overall, 7.2% met criteria of classic and 5.8% of non-calf IC. PAD was diagnosed in 393 cases (26.4%). In these PAD patients, 17.8% exhibited classic and 13.2% non-calf IC. Both calf and non-calf IC had similar overall accuracy for detecting PAD. Considering both categories as a whole, the sensitivity of IC to predict a low ABI was 31% and the specificity 93%., Conclusions: Non-calf IC is comparable to classic IC for the diagnosis of PAD in patients with no known arterial disease. The systematic implementation of Edinburgh Claudication Questionnaire could be a valuable call-to-action to improve clinical evaluation of PAD, bearing in mind that PAD detected by either non-calf or classic IC must be confirmed by ABI testing.
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- 2009
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64. [Cardiovascular complications at 1-year of follow-up in patients with atherothrombosis. On behalf of Spain's REACH Registry].
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Suárez C, Castillo J, Esmatjes E, Sala J, Cairols M, Montoto C, and Barberá G
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- Aged, Cardiovascular Diseases mortality, Female, Follow-Up Studies, Humans, Male, Prospective Studies, Registries, Spain, Time Factors, Atherosclerosis complications, Cardiovascular Diseases epidemiology, Cardiovascular Diseases etiology, Thrombosis complications
- Abstract
Background and Objective: The REACH Registry is the largest worldwide designed to obtain information on cardiovascular risk factor control and preventive treatment in a population who have, or are at risk of having, symptoms of atherothrombosis. The objective of this study is to show the results of cardiovascular events obtained in a sample of the Spanish population at one year follow-up and intervention., Material and Method: The REACH Spain registry is a prospective cohort study of subjects with vascular risk factors (ORF) for atherothrombosis or with symptomatic vascular disease (VD): coronary artery disease (CAD) and/or cerebrovascular disease (CVD) and/or peripheral artery disease (PAD). The main outcome measures were rates of all-cause mortality, cardiovascular (CV) death, and the overall combined CV death, myocardial infarction (MI), or stroke and CV hospitalization at one year follow-up., Results: In Spain 2,516 patients were recruited and 2,252 completed one year follow-up, the mean age was 68,1 (73,8% men), 11,6% of subjects with ORF and 88,5% with VD, 55% with CAD, 33% with CVD and 17% with PAD. The annual rate of all-cause mortality in VD and ORF groups were 3,57% and 1,98% (NS) respectively, while for CV death they were 2,69% and 0,62% (P<.05) and for overall combined CV death myocardial infarction (MI), or stroke and CV hospitalization they were 15,34% and 5,47% (P=.0001). The annual rate of CV death for CAD, CVD and PAD groups were 3,47%, 2,78% and 1,46% respectively, and for the overall combined CV death, myocardial infarction (MI) , or stroke and CV hospitalization they were 18,52%, 13,75% and 14,52%. These event rates increased with the number of symptomatic arterial disease locations from 0,1,2 or 3 for CV death (0,62%, 2,46%, 3,55% and 4,32%, respectively P<.05) and for overall combined CV death myocardial infarction (MI), or stroke and CV hospitalization (5,50%, 4,18%, 20,59% y 19,40%, respectively P<.0001). At one year follow-up, 82,8% of the patients were with at least one antiplatelet drug and 86,2% were receiving lipid-lowering agents., Conclusions: The REACH Spain Registry at one year follow-up in patients with atherothrombotic disease or at risk of having symptoms of atherothrombosis shows a high rate of all-cause mortality and of overall combined major CV events, which is becoming higher as the number of symptomatic arterial disease locations increases.
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- 2009
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65. A randomised open-label trial comparing long-term sub-cutaneous low-molecular-weight heparin compared with oral-anticoagulant therapy in the treatment of deep venous thrombosis.
- Author
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Romera A, Cairols MA, Vila-Coll R, Martí X, Colomé E, Bonell A, and Lapiedra O
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- Administration, Oral, Age Factors, Female, Fibrin Fibrinogen Degradation Products analysis, Humans, Injections, Subcutaneous, International Normalized Ratio, Male, Middle Aged, Neoplasms epidemiology, Prospective Studies, Recurrence, Risk Factors, Tinzaparin, Ultrasonography, Doppler, Duplex, Venous Thrombosis diagnostic imaging, Acenocoumarol therapeutic use, Anticoagulants therapeutic use, Fibrinolytic Agents therapeutic use, Heparin, Low-Molecular-Weight therapeutic use, Venous Thrombosis drug therapy
- Abstract
Objective: To evaluate whether low-molecular-weight heparin (LMWH) could be equally (or more) effective than oral anti-vitamin-K agents (AVK) in the long-term treatment of deep venous thrombosis (DVT)., Design: A randomised, open-label trial., Material and Methods: In this trial, 241 patients with symptomatic proximal DVT of the lower limbs confirmed by duplex ultrasound scan were included. After initial LMWH, patients received 6 months of treatment with full therapeutic dosage of tinzaparin or acenocoumarol. The primary outcome was the 12-month incidence of symptomatic recurrent venous thrombo-embolism (VTE). Duplex scans were performed at 6 and 12 months., Results: During the 12-month period, six patients (5%) of 119 who received LMWH and 13 (10.7%) of 122 who received AVK had recurrent VTE (p=0.11). In patients with cancer, recurrent VTE tended to be lower in the LMWH group (two of 36 [5.5%]) vs. seven of 33 [21.2%]; p=0.06). One major bleeding occurred in the LMWH group and three in the AVK group. Venous re-canalisation increased significantly at 6 months (73.1% vs. 47.5%) and at 12 months (91.5% vs. 69.2%) in the LMWH group., Conclusions: Tinzaparin was more effective than AVK in achieving re-canalisation of leg thrombi. Long-term tinzaparin was at least as efficacious and safe as AVK for preventing recurrent VTE, especially in patients with cancer.
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- 2009
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66. Prevalence of peripheral artery disease and its associated risk factors in Spain: The ESTIME Study.
- Author
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Blanes JI, Cairols MA, and Marrugat J
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- Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Humans, Ischemia epidemiology, Leg blood supply, Male, Middle Aged, Prevalence, Risk Factors, Spain epidemiology, Surveys and Questionnaires, Peripheral Vascular Diseases epidemiology
- Abstract
Aim: Several studies have demonstrated that patients with peripheral arterial disease (PAD), are at an increased risk of morbidity and mortality compared with those without PAD. However, few population-based studies have addressed the prevalence of PAD and intermittent claudication (IC). We assessed the prevalence of and the factors associated with PAD and IC in the Spanish population., Methods: A cross sectional study with 1324 participants aged 55 to 84 years randomly selected from the census was conducted in 12 Spanish regions. The presence of PAD and IC was determined by an ankle-brachial index (ABI) <0.90 in either leg and by means of the Edinburgh questionnaire, respectively, fulfilled together with a detailed past history. All participants had blood pressure, body mass index, glycemia, and lipid profile measured., Results: The response rate was 63.9% (846/1 324). ABI prevalence of PAD was 8.03% The prevalence of symptoms of definite or atypical IC was 6%. Subjects with an ABI <0.9 were more likely to be older, men, diabetics, current smokers, with coronary heart disease, with higher systolic pressure and with higher triglyceride levels than participants with ABI 0.9., Conclusions: ESTIME study confirms the high prevalence of asymptomatic PAD, and its relation with typical cardiovascular risk factors. ABI provides early diagnosis before claudication symptoms in a high proportion of patients. ABI could contribute to developing early prevention programmes.
- Published
- 2009
67. Education in vascular surgery: critical issues around the globe-training and qualification in vascular surgery in Europe.
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van Bockel JH, Bergqvist D, Cairols M, Liapis CD, Benedetti-Valentini F, Pandey V, and Wolfe J
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- Europe, Humans, Education, Medical, Continuing methods, Specialties, Surgical education, Vascular Surgical Procedures education
- Abstract
In 1958, the Union Européene des Médecins Spécialistes (UEMS), or European Union (EU) of Medical Specialists the European Union, was founded by the professional organizations of medical specialists in Europe. Among the objectives of the UEMS are to promote the highest level of patient care in the EU and to promote the harmonization of high-quality training programs within the various specialities throughout the EU. Within the 38 Specialist Sections of the UEMS are the European Boards, which are the working groups of the Specialist Sections. In 2005 Vascular Surgery was recognized as a separate and independent Section, a monospecialty, within the UEMS. The efforts of the UEMS are directed at facilitating the free exchange of training and work of trainees and medical specialists between EU countries. This situation, in combination with large differences in requirements and length of training in vascular surgery within the EU, stresses the importance of harmonization in training and certification in vascular surgery within the EU. For that reason, the European Board of Vascular Surgery has organized voluntary examinations yearly since 1996. The candidates who pass qualify as "Fellow of the European Board of Vascular Surgery" (FEBVS) since 2005. The first part of the examination evaluates the eligibility of the candidate (Certificate of Completion of Specialist Training, training center, logbook). The second part is a viva voce assessment that includes (1) case analyses, (2) a review of a scientific article, (3) an overall assessment, (4) a technical skills, and (5) an endovascular skills assessment. To pass the examination, the candidates must achieve a 67% success rate in each part of the examination. During the last 10 years, approximately 75% of the candidates have successfully taken the examination. In the near future the Section and Board, in close collaboration with the vascular societies in the EU, will develop a European vascular surgical syllabus and curriculum that will further harmonize and professionalize the training and certification of vascular surgery in Europe.
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- 2008
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68. [Prevalence of asymptomatic peripheral artery disease detected by the ankle-brachial index in patients with cardiovascular disease. MERITO II study].
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Mostaza JM, Manzano L, Suárez C, Cairols M, Ferreira EM, Rovira E, Sánchez A, Suárez-Tembra MA, Estirado E, Estrella Jde D, Vega F, and Sánchez-Zamorano MA
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- Aged, Cardiovascular Diseases complications, Female, Humans, Male, Peripheral Vascular Diseases etiology, Prevalence, Prospective Studies, Ankle Brachial Index, Peripheral Vascular Diseases diagnosis, Peripheral Vascular Diseases epidemiology
- Abstract
Background and Objective: Patients with polyvascular disease have an increased rate of cardiovascular events and death. Their identification would define a subgroup of the population at very high risk, who would be candidates to intensified preventive measures. The objective of the present study was to evaluate the prevalence of subclinical peripheral artery disease in subjects with a previous diagnosis of vascular disease in other territories., Patients and Method: Subjects with a coronary or a cerebrovascular event between 3 months and 5 years, and who were attended at internal medicine outpatient clinics from Spain were included in the study. All patients had a clinical history, a physical examination, a blood and urine analysis, and a measurement of the ankle-brachial index (ABI)., Results: A total of 1203 patients (64% males; mean age: 74.3 years), were included in the study. A previous coronary event was reported in 55.4% of the participants, cerebrovascular disease in 38%, and a clinical history of disease in both territories in 6.7%. The prevalence of a low ABI (< 0,9) was 33.8%, 32.4% and 53.9% for each group, respectively. In a multivariate analysis, factors associated with a low ABI were age, smoking habit, diabetes, a reduced glomerular filtration rate, systolic blood pressure and the presence of clinical disease in both territories upon inclusion. The sensitivity of both, the Edinburgh questionnaire and pulse palpation for detecting and ABI below 0.9, were low., Conclusions: Prevalence of a low ABI is elevated in asymptomatic patients with coronary or cerebrovascular disease, particularly if there are clinical manifestations in both territories.
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- 2008
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69. Sub-clinical vascular disease in type 2 diabetic subjects: relationship with chronic complications of diabetes and the presence of cardiovascular disease risk factors.
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Mostaza JM, Suarez C, Manzano L, Cairols M, López-Fernández F, Aguilar I, Diz Lois F, Sampedro JL, Sánchez-Huelva H, and Sanchez-Zamorano MA
- Subjects
- Aged, Aged, 80 and over, Ankle, Electrocardiography, Female, Humans, Male, Middle Aged, Risk Factors, Ultrasonography, Brachial Artery diagnostic imaging, Cardiovascular Diseases complications, Cardiovascular Diseases diagnosis, Diabetes Mellitus, Type 2 complications, Diabetic Angiopathies diagnosis
- Abstract
Background: We evaluated the association between a low ankle-brachial index (ABI), chronic complications of diabetes, and the presence of traditional cardiovascular disease risk factors in subjects with type 2 diabetes but without known cardiovascular disease., Methods: We included diabetic subjects (n=923; 52% male; age range 50-85 years) without clinical evidence of coronary, cerebrovascular, or peripheral artery disease (PAD). A history of nephropathy, retinopathy, or neuropathy was collected from the medical records. A 12-lead electrocardiogram and ABI measurements were conducted on all study participants., Results: The mean duration of diabetes was 9.6 years. Prevalence of a low ABI (<0.9) was 26.2%. Multivariate analysis indicated that factors significantly associated with a low ABI were age (OR: 1.06; 95%CI: 1.033-1.084; p<0.001), plasma triglyceride concentration (OR: 1.002; 95%CI: 1.001-1.004; p=0.006), duration of diabetes (OR: 1.029; 95%CI: 1.008-1.051; p=0.007), and smoking habit (OR: 1.755; 95%CI: 1.053-2.925; p=0.03). The presence of nephropathy, neuropathy, retinopathy, left ventricular hypertrophy, left bundle branch block, and atrial fibrillation were all associated with a low ABI, but only renal disease remained significant after adjusting for age, duration of diabetes, and cardiovascular risk factors., Conclusion: A low ABI is highly prevalent in subjects with diabetes and is related to age, duration of diabetes, smoking habit, and hypertriglyceridemia. Although chronic complications are frequently associated with a low ABI, only renal damage is independently associated with peripheral artery disease.
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- 2008
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70. The normal cellular prion protein and its possible role in angiogenesis.
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Turu M, Slevin M, Ethirajan P, Luque A, Elasbali A, Font A, Gaffney J, Cairols M, Kumar P, Kumar S, and Krupinski J
- Subjects
- Animals, Brain cytology, Cell Survival, Copper metabolism, Endothelium, Vascular cytology, Endothelium, Vascular physiology, Homeostasis, Humans, Ligands, Neurons cytology, Neurons physiology, Oxidative Stress, PrPC Proteins genetics, Reference Values, Signal Transduction, Synapses physiology, Zinc metabolism, Brain physiology, PrPC Proteins metabolism
- Abstract
Cellular Prion Protein (PrPc) is a ubiquitous glycoprotein present on the surface of endothelial cells. Resting vascular endothelial cells show minimum expression of PrPc and can constitutively release PrPc. PrPc participates in cell survival, differentiation and angiogenesis. During development, neonatal brain endothelial cells transiently express PrPc. Our group recently reported upregulation of PrPc in microvessels from ischemic brain regions in stroke patients. Ischemia/hypoxia induces PrPc expression through the activation of extracellular signal-regulated kinase (ERK). All these data suggest that PrPc plays an important role in angiogenic responses. In addition, PrPc participates in cellular function in the central nervous system, since PrPc is also highly expressed in neurons. PrPc binds copper, suggesting a role in copper metabolism. PrPc also protects cells against oxidative stress and it seems to be involved in neuroprotection. Several studies have demonstrated that PrPc prevents cells from apoptosis and subsequent tissue damage. Moreover, PrPc plays an important role in the immune response. Here, we review the multiple functions of PrPc with a special attention to its recently reported role in angiogenesis.
- Published
- 2008
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- View/download PDF
71. Management of chronic venous disorders of the lower limbs: guidelines according to scientific evidence.
- Author
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Nicolaides AN, Allegra C, Bergan J, Bradbury A, Cairols M, Carpentier P, Comerota A, Delis C, Eklof B, Fassiadis N, Georgiou N, Geroulakos G, Hoffmann U, Jantet G, Jawien A, Kakkos S, Kalodiki E, Labropoulos N, Neglen P, Pappas P, Partsch H, Perrin M, Rabe E, Ramelet AA, Vayssaira M, Ioannidou E, and Taft A
- Subjects
- Cardiovascular Agents therapeutic use, Catheter Ablation, Chronic Disease, Diagnostic Imaging, Endoscopy, Humans, Leg Ulcer therapy, Ligation, Microcirculation, Sclerotherapy, Stockings, Compression, Varicose Veins classification, Varicose Veins diagnosis, Vascular Surgical Procedures, Venous Insufficiency classification, Venous Insufficiency diagnosis, Venous Thrombosis physiopathology, Venous Thrombosis prevention & control, Lower Extremity blood supply, Varicose Veins physiopathology, Varicose Veins therapy, Venous Insufficiency physiopathology, Venous Insufficiency therapy
- Published
- 2008
72. [Risk factor control and treatment of atherothrombosis. Spain REACH Registry].
- Author
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Suárez C, Cairols M, Castillo J, Esmatjes E, Sala J, Llobet X, and Palma JC
- Subjects
- Atherosclerosis drug therapy, Atherosclerosis prevention & control, Cardiovascular Diseases drug therapy, Cerebrovascular Disorders drug therapy, Cerebrovascular Disorders prevention & control, Coronary Disease drug therapy, Coronary Disease prevention & control, Female, Fibrinolytic Agents therapeutic use, Humans, Hypolipidemic Agents therapeutic use, Male, Middle Aged, Peripheral Vascular Diseases drug therapy, Peripheral Vascular Diseases prevention & control, Platelet Aggregation Inhibitors therapeutic use, Primary Prevention, Risk Factors, Sampling Studies, Spain, Thrombosis drug therapy, Thrombosis prevention & control, Atherosclerosis therapy, Cardiovascular Diseases prevention & control, Registries, Thrombosis therapy
- Abstract
Background and Objective: The REACH Registry is the largest worldwide registry designed to obtain information on cardiovascular risk factor control and preventive treatment in a population who have, or are at high risk of having, symptoms of atherothrombosis. The objective of this study is to show the results obtained in a sample of the Spanish population included in that registry., Patients and Method: Registry of consecutive patients who have risk factors only (RFO) for atherothrombosis or who have symptomatic vascular disease (VD): coronary heart disease (CHD) and/or cerebrovascular disease (CVD) and/or peripheral artery disease (PAD). Cardiovascular risk factor control and the use of antithrombotic and lipid lowering therapy were evaluated., Results: In Spain 2,515 patients were recruited; 297 had RFO and 2,218 had VD: 61.4% with CHD, 36.6% with CVD and 18.7% with PAD. The rates of noncontrolled blood pressure, glycemia, total cholesterol and triglyceride levels in the RFO group compared to those of the VD group were: 76.5% vs 57.1% (p < 0.005), 61.6% vs 30.9% (p < 0.005), 55.7% vs 41.3% (p < 0.005) and 45.5% vs 35.1% (p < 0.005), respectively. The antiplatelet therapy rate in these two groups was 44.1% vs 86.5% (p < 0.005), the anticoagulant therapy rate was 11.4% vs 12.6% (no significant difference) and statin therapy rate was 65.2% vs 65.6% (no significant difference). Significant differences were found among the CHD, CVD and PAD groups as regards noncontrolled blood pressure rate (49.8%. 57.1% and 67.1%, respectively p < 0.005), total cholesterol control rate (41.3%, 48.2% and 50.2% respectively, p < 0.005) as well as antiplatelet therapy rate (86.5%. 83.2% and 81.6% respectively p < 0.005) and statin therapy rate (78.2%. 51.9% and 57.8% respectively p < 0.005)., Conclusions: Cardiovascular risk factor control in subjects at high risk of atherothrombosis or who have established VD is poor. It is poorer in primary prevention and in PAD patients. Whilst the use of statins is insufficient, the use of antithrombotic medication is acceptable in secondary prevention but considerably lacking in primary prevention.
- Published
- 2007
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- View/download PDF
73. D-dimer local expression is increased in symptomatic patients undergoing carotid endarterectomy.
- Author
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Krupinski J, Catena E, Miguel M, Domenech P, Vila R, Morchon S, Rubio F, Cairols M, Slevin M, and Badimon L
- Subjects
- Aged, Blotting, Western, Carotid Arteries diagnostic imaging, Carotid Arteries pathology, Carotid Artery Diseases blood, Carotid Artery Diseases diagnosis, Enzyme-Linked Immunosorbent Assay, Female, Humans, Hypercholesterolemia complications, Intracranial Arteriosclerosis blood, Intracranial Arteriosclerosis diagnosis, Male, Middle Aged, Ultrasonography, Carotid Artery Diseases metabolism, Carotid Artery Diseases surgery, Endarterectomy, Carotid, Fibrin Fibrinogen Degradation Products metabolism, Intracranial Arteriosclerosis metabolism, Intracranial Arteriosclerosis surgery
- Abstract
Background: Although atherosclerosis is a silent widespread disease, the focal character of the lesions triggering the clinical manifestations is unquestionable. We hypothesized that symptomatic patients with advanced, unstable carotid plaques have increased local intraplaque and circulating levels of fibrin-fibrinogen related products., Methods: Plaque tissue and plasma samples were studied in 106 patients undergoing endarterectomy for symptomatic and asymptomatic carotid disease. Fibrin-fibrinogen related products were evaluated by ELISA, Western-blotting, and histology. All tested parameters were compared with patient carotid symptomatology, multiple vascular risk factors (VRF), bilateral carotid pathology, ultrasound examination, and previous therapies with statins and/or antiplatelet drugs., Results: In symptomatic patients, plasma D-dimer was elevated in patients with unstable carotid plaques (UNS) compared with stable (STA) ones (857+/-121 vs. 692+/-156 ng/ml, p=0. 026). Furthermore, plasma D-dimer was significantly increased in patients with a coexistence of carotid and coronary artery disease, compared to others (976+/-325 vs. 714+/-197 ng/ml; p<0.001). Intra-plaque D-dimer content was increased in ulcerated-complicated (UC) plaques compared with fibrous non-complicated (F) plaques in symptomatic patients (5.9+/-1 vs. 1.8+/-1, p<0.001), and in patients with hypercholesterolaemia, compared with those with normal cholesterol levels (6.1+/-1 vs. 2.9+/-0.7; p=0.027). However, there was no correlation between D-dimer content in the carotid plaque and plasma D-dimer levels., Conclusions: Hypercholesterolemia and UC plaques appear to be associated with high fibrin intraplaque turnover as demonstrated by higher intraplaque D-dimer. Plasma markers of fibrin turnover were increased in UNS plaques, and in patients with coexisting carotid and coronary artery disease. Although, both plasma and plaque D-dimers were associated with unstable carotid disease, the usefulness of the measurement of plasma D-dimer in these patients should be confirmed by prospective studies.
- Published
- 2007
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74. [Value of the ankle-brachial index in cardiovascular risk stratification of patients without known atherotrombotic disease. MERITO study].
- Author
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Manzano L, Mostaza JM, Suárez C, Cairols M, Redondo R, Valdivielso P, Monte R, Blázquez JC, Ferreira EM, Trouillhet I, González-Igual JJ, and Sánchez-Zamorano MA
- Subjects
- Aged, Aged, 80 and over, Albuminuria complications, Ankle, Cross-Sectional Studies, Dyslipidemias complications, Female, Heart Rate, Humans, Hypertension complications, Life Style, Male, Middle Aged, Peripheral Vascular Diseases diagnosis, Peripheral Vascular Diseases epidemiology, Prevalence, Risk Assessment, Risk Factors, Smoking adverse effects, Surveys and Questionnaires, Cardiovascular Diseases etiology, Diabetes Complications, Peripheral Vascular Diseases complications
- Abstract
Background and Objectives: Peripheral arterial disease detected by measurement of ankle-brachial index enables the identification of asymptomatic patients with target organ damage. We have investigated the prevalence of peripheral arterial disease (ankle-brachial index < 0.9), and its potential clinical-therapeutic impact, in patients without known atherotrombotic disease from internal medicine practices., Patients and Method: It was a multicenter, cross-sectional, observational study. Outpatients aged 50 through 80 years, with either diabetes or a SCORE risk estimation of at least 3%, were enrolled., Results: A total of 1,519 subjects (58% men) were evaluated, 917 with diabetes (61%). The mean age (standard deviation) was 66.2 (8.3) years. The prevalence of an ankle-brachial index < 0.9 was 26.19%. In multiple logistic regressions the risk factors associated to an ankle-brachial index < 0.9 were age, sedentary lifestyle, smoking, macroalbuminuria, and heart rate. There was a significant relationship between the ankle-brachial index and the SCORE risk estimation. With respect to the therapeutic aims of the patients with an ankle-brachial index < 0.9, only 21% were taking antiplatelet drugs, 26% showed low density lipoproteins-cholesterol values < 100 mg/dl (53% < 130 mg/dl), and 16% displayed recommended blood pressure levels., Conclusions: Measurement of ankle-brachial is useful to reclassify as high risk a significant proportion of patients without known previous atherotrombotic disease. The ankle-brachial index should be incorporated into routine cardiovascular evaluation, particularly in subjects with diabetes or a score risk assessment > or = 3%.
- Published
- 2007
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75. Relationship between ankle-brachial index and chronic kidney disease in hypertensive patients with no known cardiovascular disease.
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Mostaza JM, Suarez C, Manzano L, Cairols M, García-Iglesias F, Sanchez-Alvarez J, Ampuero J, Godoy D, Rodriguez-Samaniego A, and Sanchez-Zamorano MA
- Subjects
- Aged, Aged, 80 and over, Albuminuria etiology, Albuminuria physiopathology, Ankle blood supply, Chronic Disease, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 physiopathology, Female, Glomerular Filtration Rate physiology, Humans, Hypertension physiopathology, Kidney Diseases diagnosis, Kidney Diseases physiopathology, Male, Middle Aged, Multivariate Analysis, Peripheral Vascular Diseases diagnosis, Peripheral Vascular Diseases physiopathology, Regional Blood Flow physiology, Risk Factors, Spain, Brachial Artery physiopathology, Hypertension complications, Kidney Diseases complications, Peripheral Vascular Diseases complications
- Abstract
Both decreased GFR and albuminuria are associated with an elevated prevalence of peripheral artery disease. However, the combined effects of these alterations previously were not evaluated. Patients with hypertension and with no known vascular disease (n = 955; mean age 66 yr; 56% male) were selected from internal medicine outpatient clinics throughout Spain. Cardiovascular risk factors, urinary albumin excretion, and the ankle-brachial index (ABI) were assessed in all participants. GFR was estimated according to the Cockroft-Gault equation. Of the study population, 62% had diabetes, 23.8% had a GFR <60 ml/min per 1.73 m2, and 43.8% had albuminuria. The prevalence of ABI <0.9 was greater in patients with a GFR <60 ml/min per 1.73 m2 (37.4 versus 24.3%; P < 0.0001) and in those who had albuminuria (32.2 versus 23.3%; P = 0.001). In patients with both alterations, the prevalence of ABI <0.9 was 45.7%. Multivariate analysis indicated that the factors that were associated independently with low ABI were age (odds ratio [OR] 1.06; 95% confidence interval [CI] 1.03 to 1.08; P < 0.0001), triglyceride concentration (OR 1.003; 95% CI 1.001 to 1.005; P = 0.001), presence of albuminuria (OR 1.61; 95% CI 1.18 to 2.20; P = 0.003), smoking habit (OR 1.72; 95% CI 1.13 to 2.63; P = 0.012), and a GFR <60 ml/min per 1.73 m2 (OR 1.47; 95% CI 1.01 to 2.17; P = 0.049). In patients with hypertension and without known vascular disease, reduced GFR and albuminuria are associated independently with an ABI <0.9. Their combined presence characterizes a subgroup of the population who have an elevated prevalence of peripheral artery disease and could benefit from early diagnosis and treatment.
- Published
- 2006
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76. Intraplaque MMP-8 levels are increased in asymptomatic patients with carotid plaque progression on ultrasound.
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Turu MM, Krupinski J, Catena E, Rosell A, Montaner J, Rubio F, Alvarez-Sabin J, Cairols M, and Badimon L
- Subjects
- Aged, Carotid Arteries pathology, Carotid Artery Diseases pathology, Disease Progression, Female, Humans, Ischemia pathology, Male, Matrix Metalloproteinase 2 biosynthesis, Matrix Metalloproteinase 9 biosynthesis, Middle Aged, Ultrasonography, Carotid Arteries diagnostic imaging, Carotid Arteries enzymology, Carotid Artery Diseases diagnostic imaging, Carotid Artery Diseases enzymology, Gene Expression Regulation, Enzymologic, Matrix Metalloproteinase 8 biosynthesis
- Abstract
Carotid atherosclerotic plaque remodelling and increased risk of symptomatic plaque rupture seem to be partially mediated by matrix metalloproteinases (MMPs). In this study, we have investigated whether different MMPs are related to carotid atherosclerosis or to recent ischaemic brain disease. Eighty-four consecutive patients undergoing carotid endarterectomy for symptomatic and asymptomatic disease were studied. Plaques were analysed by ultrasound and later by morphology. Plasma MMP-2, MMP-8 and MMP-9 levels were quantified by ELISA. MMP expression and activity in carotid plaques was analysed by Western blotting and in situ zymography. Results were analysed with respect to plaque stability, morphology, symptomatic disease, presence of vascular risk factors and plasma markers of acute inflammation as high sensitivity C-reactive protein (hsCRP), fibrinogen, D-dimer and white blood cell counts. Patients with hypoechogenic plaques on ultrasound had more plasma MMP-8 (p = 0.04) and increased MMP activity as assessed by in situ zymography. Asymptomatic patients with plaque progression had more active intraplaque MMP-8 than asymptomatic patients without plaque progression. Presence of recent intraplaque haemorrhage or past history of CAD was related to increased activity of MMPs as assessed by in situ zymography (p < 0.01, CI 95% 0.8-1.0). Plasma MMP-8 and MMP-9, but not MMP-2 levels, decrease with time after ischaemic stroke. Patients with hypertension had more intraplaque active MMP-9 than normotensive (p = 0.03, CI 95% 0.7-1.0). Hypoechogenic carotid plaques had increased MMP activity and asymptomatic patients with plaque progression show increase intraplaque MMP-8 levels.
- Published
- 2006
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77. [Ankle brachial index and cardiovascular risk].
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Mostaza JM, Vicente I, Cairols M, Castillo J, González-Juanatey JR, Pomar JL, and Lahoz C
- Subjects
- Ankle blood supply, Anthropometry methods, Brachial Artery physiopathology, Cardiovascular Diseases physiopathology, Cerebrovascular Disorders diagnosis, Clinical Trials as Topic, Humans, Risk Factors, Blood Pressure, Cardiovascular Diseases diagnosis
- Published
- 2003
- Full Text
- View/download PDF
78. Factors increasing the mortality rate for patients with ruptured abdominal aortic aneurysms.
- Author
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Alonso-Pérez M, Segura RJ, Sánchez J, Sicard G, Barreiro A, García M, Díaz P, Barral X, Cairols MA, Hernández E, Moreira A, Bonamigo TP, Llagostera S, Matas M, Allegue N, Krämer AH, Mertens R, and Coruña A
- Subjects
- Age Factors, Aged, Aged, 80 and over, Aortic Aneurysm, Abdominal surgery, Aortic Rupture surgery, Blood Pressure physiology, Creatinine blood, Female, Hematocrit, Hospital Mortality, Humans, Logistic Models, Male, Middle Aged, Postoperative Complications etiology, Postoperative Complications mortality, Predictive Value of Tests, Risk Factors, Surgical Instruments, Survival Analysis, Treatment Outcome, Aortic Aneurysm, Abdominal complications, Aortic Aneurysm, Abdominal mortality, Aortic Rupture complications, Aortic Rupture mortality
- Abstract
The objective of this report was to analyze the current surgical results of operative treatment in patients suffering ruptured AAA (abdominal aortic aneurysms) and to define those independent predictive factors for mortality. During a period of 2 years, from January 1996 to December 1997, 144 patients operated on for ruptured AAA in 10 hospitals were included in a multicenter retrospective study. Among the collected variables concerning each patient, those with potential relation to surgical mortality were studied: gender, age, diabetes, hypertension, cardiopathy, pulmonary obstructive disease, preoperative renal dysfunction, symptomatic cerebrovascular disease, peripheral vascular disease, hematocrit on admission, preoperative hypotension < 80 mmHg, loss of consciousness, cardiac arrest, aortic aneurysm location (infrarenal versus non-infrarenal), iliac involvement, aneurysm size, type of rupture, left renal vein ligature, ligature of a patent inferior mesenteric artery, place of aortic cross-clamping, type of grafting, exclusion of both hypogastric arteries, venous technical complications, associated surgery, use of cell saver, intraoperative blood loss, and postoperative complications (renal failure, sepsis, coagulopathy, cardiac complications, pulmonary complications, colon ischemia, prosthetic graft complications, and need for reoperation). Those variables with statistical significance in the univariate analysis were introduced into a multivariate logistic regression model to determine the independent predictors of death. From our results we concluded that surgery for ruptured abdominal aortic aneurysms continues to have an excessively high mortality rate. Even though some preoperative variables could be identified as predictors of mortality, an absolute mortality risk has not yet been determined and the decision to negate surgery should be individualized rather than taken on that basis only. Early diagnosis and treatment of symptomatic aneurysms would improve mortality figures and selective screening should be contemplated.
- Published
- 2001
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79. Primary aorto-oesophageal fistula due to oesophageal carcinoma. Report of a successfully managed case.
- Author
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Cairols MA, Izquierdo LM, Barjau E, Iborra E, and Romera A
- Subjects
- Angiography, Aortic Diseases surgery, Blood Vessel Prosthesis Implantation, Carcinoma, Squamous Cell surgery, Esophageal Fistula surgery, Esophageal Neoplasms surgery, Gastrectomy, Gastrointestinal Hemorrhage surgery, Humans, Male, Middle Aged, Postoperative Complications diagnostic imaging, Postoperative Complications surgery, Recurrence, Reoperation, Vascular Fistula surgery, Aortic Diseases diagnostic imaging, Carcinoma, Squamous Cell diagnostic imaging, Esophageal Fistula diagnostic imaging, Esophageal Neoplasms diagnostic imaging, Gastrointestinal Hemorrhage diagnostic imaging, Vascular Fistula diagnostic imaging
- Abstract
Aorto-oesophageal fistula is a rare but often fatal entity causing upper gastrointestinal bleeding. Amongst the different aetiologies described, the commonest is rupture of a thoracic aortic aneurysm into the oesophagus. This entity was first reported in 1818, and only recently have successfully treated cases been published. Other causes such as postoperative complications, tuberculosis and trauma are less common. Oesophageal malignancy perforating the aorta is a rarity. The authors describe a case of aortic perforation secondary to an oesophageal carcinoma, treated with initial success. The clinical onset was a massive upper gastrointestinal haemorrhage. The diagnosis, once the bleeding was controlled, was arrived at after CT-scanning and arteriography. A Dacron prosthesis was interposed into the descending thoracic aorta to restore aortic flow; later an oesophagectomy plus oesophagostomy and jejunostomy were carried out.
- Published
- 2000
80. Embolization of an anomalous bronchial artery aneurysm in a patient with agenesis of the left pulmonary artery.
- Author
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Sancho C, Domínguez J, Escalante E, Hernandez E, Cairols M, and Martinez X
- Subjects
- Aneurysm complications, Aneurysm diagnosis, Angiography, Digital Subtraction, Hemoptysis diagnosis, Hemoptysis etiology, Hemoptysis therapy, Humans, Magnetic Resonance Angiography, Male, Middle Aged, Radiography, Thoracic, Tomography, X-Ray Computed, Aneurysm therapy, Bronchial Arteries, Embolization, Therapeutic, Pulmonary Artery abnormalities
- Published
- 1999
- Full Text
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81. The role of the circle of Willis in carotid occlusion: assessment with phase contrast MR angiography and transcranial duplex.
- Author
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Miralles M, Dolz JL, Cotillas J, Aldoma J, Santiso MA, Giménez A, Capdevila A, and Cairols MA
- Subjects
- Adolescent, Adult, Aged, Blood Flow Velocity, Brain Damage, Chronic diagnosis, Brain Damage, Chronic diagnostic imaging, Brain Ischemia diagnostic imaging, Carotid Artery, Internal diagnostic imaging, Carotid Artery, Internal pathology, Carotid Stenosis diagnostic imaging, Cerebral Arteries diagnostic imaging, Cerebral Arteries pathology, Cerebral Infarction diagnostic imaging, Cerebrovascular Circulation, Circle of Willis diagnostic imaging, Collateral Circulation, Female, Humans, Ischemic Attack, Transient diagnosis, Ischemic Attack, Transient diagnostic imaging, Male, Middle Aged, Ophthalmic Artery diagnostic imaging, Ophthalmic Artery pathology, Regional Blood Flow, Systole, Vascular Patency, Brain Ischemia diagnosis, Carotid Stenosis diagnosis, Cerebral Infarction diagnosis, Circle of Willis pathology, Magnetic Resonance Angiography, Magnetic Resonance Imaging, Cine, Ultrasonography, Doppler, Transcranial
- Abstract
Purpose: To study the collateral pathways recruited after occlusion of the internal carotid artery (ICA), and to evaluate its influence on the impairment of hemispheric blood flow supply and development of low flow infarcts., Methods: 38 patients with ICA occlusion (18 asymptomatic; five transient ischaemic attacks; and 15 strokes) were included. Infarcts on cerebral MR scanning were categorised in order to differentiate patients with territorial infarcts or no lesion (group I; n = 22) from those with brain damage due to low flow (group II; n = 16). Patency and direction of flow in the communicating arteries were assessed by means of cine phase contrast MR angiography (PC-MRA). Flow velocity in the middle cerebral artery (MCA) was measured by means of transcranial Duplex (TCD)., Results: Cine PC-MRA revealed a reversed ophthalmic artery blood flow ipsilateral to the ICA occlusion in all except two patients in group I and one patient in group II (NS). Posterior to anterior flow in the ipsilateral posterior communicating artery (PCoA) was detected in 16 (73%) patients in group I and in 13 (81%) in group II (NS). In contrast, reversed blood flow in the ipsilateral A1 segment of the anterior cerebral artery, through a patent anterior communicating artery (ACoA), was identified in 19 (86%) patients of group I, vs. 7 (44%) of group II (p = 0.005). The relative risk of low-flow infarcts was significantly higher in those cases with non-functioning ACoA (odds ratio = 8.1; p < 0.05). TCD showed a lower peak systolic velocity (PSV) in the ipsilateral MCA than in the contralateral one (60 +/- 9 cm/s vs. 90 +/- 11 cm/s; p < 0.005). Those patients without crossed flow through the ACoA, showed an even lower PSV in the ipsilateral MCA (55 +/- 7 cm/s vs. 64 +/- 9 cm/s; p = 0.03)., Conclusions: These data suggest that even though ICA occlusion may occur without cerebral damage, collateral blood supply is not enough to maintain normal hemispheric perfusion. The ACoA may be a key collateral pathway as a non-functioning ACoA is associated with an increased risk of developing low-flow infarcts.
- Published
- 1995
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82. Carotid endarterectomy: who should perform it?
- Author
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Cairols MA
- Subjects
- Humans, Endarterectomy, Carotid statistics & numerical data
- Published
- 1995
- Full Text
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83. An exceptional case of popliteal entrapment syndrome.
- Author
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Cairols MA, Blanes I, Gimenez A, Miralles M, Sieyro F, Latorre E, and Cotillas J
- Subjects
- Adolescent, Aneurysm diagnostic imaging, Angiography, Digital Subtraction, Constriction, Pathologic complications, Constriction, Pathologic diagnostic imaging, Female, Humans, Peripheral Vascular Diseases diagnostic imaging, Syndrome, Aneurysm etiology, Peripheral Vascular Diseases complications, Popliteal Artery
- Published
- 1994
- Full Text
- View/download PDF
84. Renal duplex scanning: correlation with angiography and isotopic renography.
- Author
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Miralles M, Santiso A, Gimenez A, Riambau V, Saez A, Daumal J, and Cairols MA
- Subjects
- Adult, Aged, Aged, 80 and over, Captopril, Female, Humans, Hypertension, Renovascular surgery, Ischemia diagnosis, Ischemia surgery, Kidney blood supply, Male, Middle Aged, Postoperative Complications diagnosis, Renal Artery Obstruction surgery, Renin blood, Angiography, Hypertension, Renovascular diagnosis, Radioisotope Renography, Renal Artery Obstruction diagnosis, Ultrasonography
- Abstract
The purpose of this study was to assess the accuracy of Duplex scanning in detecting renovascular disease and to compare it with angiography, renal scintigraphy and captopril test for plasma renin activity and isotopic renography. A Duplex scan was performed in 92 renal arteries (46 patients) and compared to angiography. Three degrees of stenoses were established: 0-60%, 61-99% and occlusion. The peak systolic velocity (PSV) in the renal artery and its ratio to the peak velocity in the aorta (RAR) were used to discriminate stenoses > 60%. PSV in the interlobar arteries was used to assess the relative perfusion of both parenchyma. Angiography demonstrated a stenoses > 60% in 23 hypertensive patients. In all of the patients, plasma renin activity was measured and isotopic renograms (pre- and post-captopril) obtained in order to discriminate hypertension of vascular origin. A PSV in the renal artery > 210 cm/s and a RAR > 3.5 were found to be the diagnostic criteria with the best sensitivity and specificity in detecting stenoses > 60%. Based on these data, Duplex correctly identified 49/54 stenoses > 60%; 28/33 stenoses < 60%; and 5/5 occlusions (kappa 0.79). Sensitivity and specificity in detecting stenoses > 60% were 89.5 and 90.7%, respectively. The ratio between PSV in the interlobar arteries of both parenchyma accurately predicted the relative perfusion (ratio between DTPA uptake in both kidneys) in the isotopic test (n = 23, r = 0.91, p = 0.001). The captopril test (for plasma renin activity and isotopic renography) was positive in only five patients.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1993
- Full Text
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85. [Renal duplex: clinical usefulness].
- Author
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Miralles M, Giménez A, Cairols MA, Riambau V, and Sáez A
- Subjects
- Adult, Aged, Aged, 80 and over, Captopril, Humans, Middle Aged, Radiography, Radioisotope Renography, Renal Artery diagnostic imaging, Sensitivity and Specificity, Ultrasonography, Hypertension, Renovascular diagnostic imaging, Renal Artery Obstruction diagnostic imaging
- Abstract
It is the purpose of this report to focus attention on the clinical usefulness of Renal Duplex for the diagnosis of patients with vasculo-renal diseases in terms of: 1. Accuracy of Duplex/Angiography in the measurement of the renal stenosis degree. 2. Correlationship between Duplex ans Isotopic Renogram with respect to the study of the parenchyma's perfusion. 3. The effect of the inhibitors of the conversor enzyme (Captopril) on the Doppler signal of the parenchyma, comparing it with the results from the captopril test about the peripheral plasmatic renin activity and the isotopic renogram, in patients with vasculo-renal HTA. Results obtains by Duplex and Angiography were compared in 92 renal arteries from 46 patients. For both technics, three degrees of stenosis were established: 0-59%, 60-99% and occlusion. The Duplex technique identified 49/54 stenosis < 60%, 28/33 stenosis > 60% and 5/5 occlusions (Kappa 0.8). Sensibility and specificity of Duplex for the diagnosis of stenosis > 60% were, respectively, 89.5% and 90.7%; with an exactness of 90.2%. The angiographies showed stenosis > 60% in 23 patients with HTA (diastolic pressures > 100 mmHg). In all of the patients, a measurement of the plasmatic renin activity, an isotopic renogram and a Doppler of the interlobar arteries basal and post-captopril, were performed. The correlationship between Duplex and isotopic renogram with respect to the measurement of the relative renal perfusion was statistically significant (r = 0.91; p < 0.0001). The captopril test for renin and isotopic renogram were positives for 5 patients (4 with unilateral stenosis an 1 with bilateral stenosis). All of them showed severe stenosis (> 80%).(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1993
86. [Carotid surgery in Spain. Analysis of 2 national inquiries].
- Author
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Estevan JM, González MA, Valle A, Cairols M, Marco-Luque MA, and Navarro R
- Subjects
- Humans, Spain, Carotid Artery Diseases surgery, Surgical Procedures, Operative statistics & numerical data
- Published
- 1992
87. [Traumatic section of the thoracic aorta: its repair by direct aortic clamping].
- Author
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Cairols MA, Sieyro F, Miralles M, Blanes I, and Lozano P
- Subjects
- Accidents, Traffic, Adult, Aorta, Thoracic diagnostic imaging, Aorta, Thoracic immunology, Aorta, Thoracic surgery, Aortic Rupture diagnostic imaging, Constriction, Emergencies, Female, Humans, Male, Radiography, Aortic Rupture surgery
- Abstract
Traumatic section of descendent aorta, severe complication of a thoracic traumatism, requires an early recognition and restoration because its high mortality rate. Between 1988 and 1990, three patients underwent surgical approach, by direct aortic clamping [correction of clamplaje], at our Service. In two cases, a heart stoppage appeared during the clamping/unclamping [correction of clampaje/desclampaje] maneuvers. One of them had previously electrocardiographic abnormalities, suggestive of heart contusion. Two patients died, one of them during surgical procedure because an irreversible heart stoppage, and the second patient died after 7 days because of a brain hemorrhage. One case presented postoperative paraplegia. Respective rates and literature about the main factors implicated in the diagnosis and treatment of such pathology are reviewed.
- Published
- 1991
88. [Ergotamine poisoning. Two cases of peripheral ischemia].
- Author
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Cairols MA, Giménez A, Sieyro F, and Miralles M
- Subjects
- Adult, Ergotism etiology, Female, Humans, Ischemia physiopathology, Middle Aged, Arm blood supply, Ergotism complications, Foot blood supply, Ischemia etiology
- Abstract
Ergotism is a rare disorder, generally caused by iatrogenia after the administration of drugs containing ergotamine derivates. Two cases of ischemic incidents at the extremities caused by a chronic intoxication with ergotamine tartrate, after its prolonged administration in therapeutical doses as a treatment for hemicrany, are reported. A short bibliographic review about semiology and therapeutic possibilities of such toxic pathology has been made.
- Published
- 1991
89. [Thrombolytic treatment of deep venous thrombosis].
- Author
-
Martínez-Brotons F and Cairols MA
- Subjects
- Anticoagulants therapeutic use, Drug Evaluation, Heparin therapeutic use, Humans, Peptide Fragments therapeutic use, Plasminogen therapeutic use, Streptokinase therapeutic use, Urokinase-Type Plasminogen Activator therapeutic use, Fibrinolytic Agents therapeutic use, Thrombophlebitis drug therapy
- Published
- 1984
90. [Neurological complications in supra-aortic vessel surgery in relation to the method of cerebral protection employed].
- Author
-
Castaño Santa J, Capdevila JM, Pascual MA, Cairols MA, Gracia T, and Marco Luque MA
- Subjects
- Adult, Aged, Barbiturates administration & dosage, Carbon Dioxide administration & dosage, Female, Humans, Hypothermia, Induced, Intraoperative Complications, Male, Middle Aged, Brain Ischemia prevention & control, Carotid Artery, Internal surgery, Cerebral Infarction etiology, Endarterectomy adverse effects
- Published
- 1983
91. Renal artery stenosis in transplanted kidney: management and results in six patients.
- Author
-
Serrallach N, Serrate R, Franco E, Muñoz J, Aguilo F, Gutierrez R, Rius G, Montaña X, Marco-Luque M, and Cairols MA
- Subjects
- Adult, Female, Follow-Up Studies, Graft Rejection, Humans, Male, Renal Artery Obstruction etiology, Time Factors, Angioplasty, Balloon, Kidney Transplantation, Renal Artery Obstruction therapy
- Abstract
Severe hypertension and a decrease of renal function, with or without oliguria, suggest renal artery stenosis in the transplanted kidney. 6 renal artery stenoses were observed in 100 transplanted kidneys followed up for more than 3 months. In 4 patients, percutaneous transluminal angioplasty was performed. 1 patient required a new percutaneous transluminal angioplasty 3 months later and a 2nd patient was submitted to surgery after 14 months. Surgery was performed in 2 more cases, with failure in 1. It seems that the endoarteric lesion during cold perfusion could be the main etiopathological factor, when associated with rejection episodes. Percutaneous transluminal angioplasty is the treatment of choice in the management of renal artery stenosis in transplanted kidneys. Surgery must be reserved when it fails.
- Published
- 1985
- Full Text
- View/download PDF
92. Aortoiliac endarterectomy in young patients.
- Author
-
Capdevila JM, Marco-Luque MA, Cairols MA, Rancaño J, and Simeon JM
- Subjects
- Adult, Aged, Aorta, Abdominal diagnostic imaging, Aorta, Abdominal pathology, Arteriosclerosis classification, Arteriosclerosis diagnostic imaging, Endarterectomy mortality, Female, Femoral Artery surgery, Follow-Up Studies, Humans, Iliac Artery diagnostic imaging, Male, Middle Aged, Popliteal Artery surgery, Radiography, Vascular Patency, Aorta, Abdominal surgery, Arteriosclerosis surgery, Endarterectomy methods, Iliac Artery surgery
- Abstract
From 1976 to 1981 a total of 304 aortoiliac thromboendarterectomies (TEA) were carried out. Of these, 47 (16%) were performed in young patients: 25 cases were done through a transperitoneal and 22 through a retroperitoneal approach. All retroperitoneal operations were unilateral. All patients were smokers. Twenty-seven patients had incapacitant claudication, 14 had rest pain and 6 had necrotic lesions. Patency rates at four years were 78% for transperitoneal TEA and 79% for retroperitoneal unilateral TEA. These patency rates compared favorably with those obtained using similar techniques in patients over 50 years of age. In this older group, similar 4 year patency rates were 85% and 82%, respectively. The morbidity and mortality of these approaches was analyzed in patients above and below the age of 50. Our results support the use of TEA in young patients with symptomatic advanced atherosclerosis and question the wisdom of limiting the use of TEA to localized segmental lesions of the aortoiliac segment.
- Published
- 1986
- Full Text
- View/download PDF
93. [Combination of pentoxifylline with other rheologic agents in the treatment of ischemic pain at rest].
- Author
-
Aced S, Cairols MA, Marco-Luque MA, and Capdevila JM
- Subjects
- Adult, Aged, Blood Viscosity drug effects, Clinical Trials as Topic, Dextrans administration & dosage, Drug Combinations, Female, Humans, Male, Middle Aged, Pain etiology, Random Allocation, Sodium Chloride administration & dosage, Extremities blood supply, Ischemia complications, Pain drug therapy, Pentoxifylline administration & dosage, Theobromine analogs & derivatives
- Published
- 1981
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