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Abstract Introduction: In Mexico, cardiac rehabilitation (CR) as an interdisciplinary intervention with therapeutic impact in patients with heart disease is growing. There is the need to know actual conditions of CR in our country. Objectives: The objective of this National Registry is to follow-up those existing and new CR units in Mexico through the comparison between the two previous registries, RENAPREC-2009 and RENAPREC II-2015 studies. This is a descriptive study focused on diverse CR activities such as assistance training, and certification of health professionals, barriers, reference, population attended, interdisciplinarity, permanence over time, growth prospects, regulations, post-pandemic condition, integrative characteristics, and scientific research. Results: Data were collected from 45 CR centers in the 32 states, 75.5% are private practice units, 67% are new, 33% were part of RENAPREC II-2015, and 17 have continued since 2009. With a better distribution of CR units along the territory, the median reference of candidates for CR programs is 9% with a significant reduction into tiempo of enrollment to Phase II admission (19 ± 11 days). Regarding to previous registries, the coverance of Phases I, II, and III is 71%, 100%, and 93%, respectively; and a coverance increases in evaluation, risk stratification, and prescription, more comprehensive attendance and prevention strategies. Conclusions: CR in Mexico has grown in the past 7 years. Even there is still low reference and heterogeneity in specific processes, there are strengths such as interdisciplinarity, scientific professionalization of specialists, national diversification, and an official society that are consolidated over time.

https://doi.org/10.24875/acm.22000235

Esfuerzos en la detección de aneurismas aórticos y la formación de recursos humanos para la optimización de su tratamiento
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Hinojosa-Becerril, Carlos A.

; Anaya-Ayala, Javier E.

; Bobadilla-Rosado, Luis

; Arámburo-López, Juan C.

; Barragán-Galindo, Luis

; Lozano-Corona, Rodrigo

; Torres-Machorro, Adriana

; Laparra-Escareno, Hugo

Cirugía y cirujanos

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aug 2023, Volume 91 N. 4 Pages 514 - 520

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

Resumen Objetivo: Revisar los ingresos, procedimientos y defunciones intrahospitalarias asociadas a aneurismas aórticos abdominales (AAA) y analizar el impacto de la introducción de programas de formación de recursos humanos y tamizaje ultrasonográfico. Métodos: Estudio retrospectivo, se analizaron las bases de datos nacionales obtenidas del portal datos abiertos de la Dirección General de Información en Salud (DGIS) del año 2010 al 2020. Se calculó la letalidad intrahospitalaria anual y comparamos la experiencia del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ). El análisis estadístico se realizó en el programa STATA versión 17. Resultados: De acuerdo con la base nacional (BN), se registraron 899 (91%) ingresos, mientras que en el INCMNSZ 85 (9%). La mayoría pertenecía al sexo masculino (68%), un total de 811 (82%) pacientes fueron sometidos a cirugía abierta, mientras que 173 (18%) a terapia endovascular (EVAR), siendo este abordaje más frecuente en nuestra institución (p = 0.007). La mortalidad intrahospitalaria fue del 22.5%, en la BN fue del 23.9%, mientras que en el INCMNSZ fue del 16.4%, sin que encontráramos diferencia significativa (p = 0.1). Conclusiones: Los AAA continúan siendo poco reconocidos en nuestro país. La introducción de programas universitarios de especialidad y el tamizaje podría impactar en la reducción de la morbimortalidad.

Abstract Objective: To review admissions, interventions and in-hospital mortality associated to Abdominal Aortic Aneurysms (AAA), and to analyze the impact of the introduction of a training program and imaging screening at our institution. Methods: Retrospective study where hospitalizations, procedures and mortality secondary to AAA were recorded. The national databases (ND) from the Secretariat of Health were utilized from 2010 to 2020. In-hospital lethality was calculated and compared with the experience at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ). The statistical analysis was completed with the STATA version 17. Results: According to the ND, 899 (91%) hospital admissions secondary to AAA occurred, while in the INCMNSZ 85 (9%). Most of them belonged to the male gender (68%); 811 (82%) patients underwent open surgical repair, and 173 (18%) to an endovascular exclusion (EVAR), the latter approach was significantly more frequently performed at our institution (p = 0.007). The 30-day hospital mortality was 22.5%; in the ND was 23.9 vs. a 16.4% in the INCMNSZ without significant difference (p = 0.1). Conclusions: AAA remain unrecognized in our country. The introduction of University programs and imaging screening might impact in the early detection, and to reduce the morbidity and mortality associated to emergency procedures.

https://doi.org/10.24875/ciru.22000300

Analysis of clinical outcomes of arteriovenous fistula for hemodialysis access in a Mexican elderly population
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Contreras-Jimenez, Emmanuel

; Lopez-Pena, Gabriel

; Ruben-Castillo, Christopher

; Teran-Ellis, Santiago Mier y

; Cuen-Ojeda, Cesar

; Arzola-Flores, Luis H.

; Anaya-Ayala, Javier E.

; Hinojosa, Carlos A.

Cirugía y cirujanos

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apr 2023, Volume 91 N. 2 Pages 200 - 203

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

Resumen Antecedentes. El aumento de las tasas de supervivencia en los pacientes con enfermedad renal terminal ha impactado en los pacientes con acceso para hemodiálisis. Objetivo. Analizar las tasas de maduración y permeabilidad de las fístulas arteriovenosas en pacientes adultos mayores. Método. Estudio retrospectivo en el que se incluyeron pacientes a los que se realizó fístula arteriovenosa. Las tasas de maduración y permeabilidad se analizaron divididas en grupos según la edad (≥ 65 y < 65 años). Las tasas de permeabilidad se compararon mediante análisis de Kaplan-Meier. Resultados. Se analizaron 20 pacientes ≥ 65 años. La tasa de maduración global en este grupo fue del 75%, frente al 84.1% (p = 0.33) en el grupo más joven. La permeabilidad primaria a los 6 y 12 meses para el grupo ≥ 65 años fue del 93% y el 86%, respectivamente, en comparación con el 85% y el 81% en el grupo más joven (p = 0.77). Conclusiones. La fístula arteriovenosa autógena sigue siendo la opción preferida y duradera para los pacientes de edad avanzada. No encontramos diferencias en cuanto a las tasas de maduración y permeabilidad en comparación con los pacientes más jóvenes.

Abstract Objective. The increased survival rates of end-stage renal disease (ESRD) patients have impacted directly in the proportion of elderly patients requiring a reliable hemodialysis (HD) access; this group clearly demands an individualized approach. We aim to analyze maturation and patency rates of arteriovenous fistulas (AVF) in elderly patients. Methods. This was retrospective review of a database of patients that underwent AVF creation in our institution. The maturation and patency rates were analyzed divided in groups based on age (equal and greater of 65 years, and patients under 65 years). Patency rates were compared using Kaplan-Meier analysis. Results. Twenty patients ≥ 65 years old (mean 73, SD ± 5.4) were analyzed. The overall maturation rate in this group was 75% compared to 84.1% (p = 0.33) in the younger group (mean age 48 years, SD ± 17). The primary patency at 6 and 12 months for the ≥ 65 years group was 93% and 86%, respectively, compared with 85% and 81% for the younger group (p = 0.77). Conclusion. Autogenous AVF remains the preferred and durable option for elderly patients. We found no difference in terms of maturation and patency rates compared to younger patients. Standardized protocols are needed to optimally select vascular accesses.

https://doi.org/10.24875/ciru.22000217

Acute pulmonary embolism as a complication in a young male patient with a left popliteal venous aneurysm
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Contreras-Jiménez, Emmanuel

; Martínez-Quesada, Jose I.

; Miranda-Ramirez, Montserrat W.

; Anaya-Ayala, Javier E.

; Arzola-Flores, Luis H.

; Mier y Terán-Ellis, Santiago

; Cuen-Ojeda, Cesar

; Hinojosa, Carlos A.

Jornal Vascular Brasileiro

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2023, Volume 22 elocation e20220073

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Aneurismas venosos são raros, tendo uma prevalência de 0,1 a 0,2% nas séries relatadas. Os pacientes não costumam manifestar sintomas; entretanto, são propensos a desenvolver trombose venosa profunda e a complicação mais temida, embolia pulmonar. Apresentamos o caso de um homem de 36 anos previamente hígido que chegou ao serviço de emergência queixando-se de taquicardia, dispneia e dor pleurítica. Uma angiotomografia computadorizada confirmou o diagnóstico de embolia pulmonar aguda. O paciente foi tratado com trombólise sistêmica e anticoagulantes. Em exames posteriores para investigar a causa da embolia, uma tomografia computadorizada revelou dilatação fusiforme da veia poplítea esquerda medindo 3x3 cm, com enchimento incompleto devido à presença de um trombo. O paciente foi submetido a reparo cirúrgico aberto. No seguimento de 1 mês, ele estava assintomático, e uma ultrassonografia revelou a patência completa da veia poplítea, sem dilatação ou trombo. raros 01 0 0, 02 2 0,2 relatadas sintomas entretanto temida 3 queixandose queixando se taquicardia pleurítica aguda anticoagulantes x 3x cm trombo aberto mês assintomático

Abstract Venous aneurysms are rare and have a prevalence of 0.1 to 0.2% in the reported series. Typically, patients do not present any symptoms, but are prone to develop deep venous thrombosis (DVT) and the most feared complication, pulmonary embolism (PE). We present the case of a previously healthy 36-year-old man who presented at the emergency department with tachycardia, dyspnea, and pleuritic pain. A thoracic computed tomography angiography (CTA) confirmed the diagnosis of acute pulmonary embolism. He was treated with systemic thrombolysis and anticoagulation. In the further workup of the cause of the embolism, computed tomography revealed a fusiform dilation of the left popliteal vein measuring 3 by 3 centimeters (cm) with an incomplete filling defect because of thrombus presence. The patient underwent open surgical repair. At one month follow-up, he was asymptomatic, and an ultrasound revealed complete patency of the popliteal vein without dilatation or thrombus. 01 0 1 0. 02 2 0.2 series Typically symptoms DVT (DVT complication PE. PE . (PE) 36yearold yearold 36 year old tachycardia dyspnea pain CTA (CTA anticoagulation cm (cm presence repair followup, followup follow up, up follow-up asymptomatic (PE

https://doi.org/10.1590/1677-5449.202200732

Esferas de hidrogel relacionadas con oclusión intestinal
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Zurita-Martínez, Paulina M.

; Guerrero-Reséndiz, Diana A.

; Silva-Ramírez, Horacio

; Alcántara-Noguez, Carlos

; Lechuga-Mendoza, Luz A.

; Jiménez-Arrieta, Diana C.

; Vera-López, Isabel

; Torres-Hinojosa, Alejandra P.

Boletín médico del Hospital Infantil de México

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2023, Volume 80 Suppl. 1 Pages 64 - 68

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

Resumen Introducción: La obstrucción intestinal por ingesta accidental de cuerpos extraños se presenta muy rara vez en la edad pediátrica debido a que del 80 al 90% de los objetos pueden pasar libremente por el tracto gastrointestinal. Caso clínico: Se aborda el caso de una paciente de sexo femenino de 1 año 2 meses quien presentó obstrucción intestinal debido a la ingesta de esferas de hidrogel (poliacrilato de sodio). Dichas esferas, que son utilizadas como juguetes didácticos o sensoriales, aumentan de 200 a 400 veces su tamaño inicial mediante la absorción de agua. Se realizó radiografía abdominal en proyección decúbito supino, donde llamó la atención el hallazgo de defecto de llenado redondeado en asa de flanco derecho, ya que las esferas de hidrogel son radiolúcidas. El diagnóstico se estableció mediante ultrasonido abdominal, donde se reportó líquido libre peritoneal con datos de suboclusión por cuerpos extraños a nivel intestinal. Se indicó tratamiento conservador, encontrando persistencia de aumento de perímetro abdominal. Se realizó enterotomía y se encontraron las esferas impactadas a 30 centímetros de la válvula ileocecal. Conclusiones: Las esferas de hidrogel son peligrosas para la población pediátrica. La evolución de la paciente fue favorable debido al conocimiento del objeto extraño ingerido. Sobresale la conducta expectante que se tuvo que desempeñar debido a que se desconocía el crecimiento de las esferas y en qué momento no podrían continuar su paso por el tracto gastrointestinal.

Abstract Background: Bowel obstruction due to accidental ingestion of foreign objects occurs rarely in children because 80 to 90% of the objects can pass freely through the gastrointestinal tract. Case report: We report a case of a 14-month-old infant who presented bowel obstruction caused by the ingestion of hydrogel beads (sodium polyacrylate). Hydrogel beads are used as sensory and didactic toys that can increase their initial size 200 to 400 times by liquid absorption. An abdominal X-ray was perfomed in anteroposterior supine projection, where a round filling defect at the loop of the right flank was detected; this came to our attention because hydrogel beads are usually radiolucent. The diagnosis was established by abdominal ultrasound where free intraperitoneal fluid was reported with data of small bowel pseudo-obstruction by foreign objects. Conservative treatment was prescribed, finding persistence of increased abdominal perimeter, so an enterotomy was performed for their removal; finding impacted hydrogel beads 30 centimeters from the ileocecal valve. Conclusions: Hydrogel beads are dangerous for the pediatric population. The evolution of the patient was favorable thanks to the knowledge of the foreign objects ingested. The expectant behavior that had to be executed, stands out because we had no knowledge as to the maximum size of the hydrogel in the gastrointestinal tract.

https://doi.org/10.24875/bmhim.22000137

Discurso presidencial del Congreso Internacional de Angiología, Cirugía Vascular y Endovascular 2022
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Hinojosa, Carlos A.

Revista mexicana de angiología

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dec 2022, Volume 50 N. 4 Pages 119 - 125

Abstract: Es | Text: Es | PDF: Es

https://doi.org/10.24875/rma.22000041

Normal aortic diameters within the Mexican population and the impact of gender and ethnicity
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Fabiani, Mario A.

; González-Urquijo, Mauricio

; Silva-Platas, Christian

; Carrillo-Martínez, Miguel Á.

; Herrera-Vegas, Diego

; Morelli, Luis

; Vaquero-Puerta, Carlos

; Montero-Baker, Miguel

; Schonholtz, Claudio

; Hinojosa-González, David E.

; Mosquera-Anchorena, Nilo

; Reijnen, Michel

Revista mexicana de angiología

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sep 2022, Volume 50 N. 3 Pages 90 - 95

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

Resumen Antecedentes: Faltan estudios que describan el tamaño normal de la aorta en población mexicana. Objetivos: Analizar las medidas aórticas en pacientes mexicanos y compararlas con pacientes de cinco países diferentes. Métodos: Las medidas de la aorta se dividieron en mexicanos y controles. Se realizó una comparación entre etnias y grupos mediante la prueba de suma de rangos de Mann Whitney. Resultados: El registro incluyó a 166 pacientes, 106 (63.8%) eran de México y 60 (36.1%) en el grupo control. Los pacientes mexicanos tenían diámetros aórticos más pequeños en comparación con el grupo control, a nivel del ostium de la arteria renal derecha, la arteria mesentérica inferior y la bifurcación aórtica. La población hispana tenía diámetros aórticos significativamente más pequeños desde el nivel de la arteria celíaca hasta la bifurcación aórtica. Conclusión: Los diámetros aórticos normales en la población mexicana son menores en comparación con otros países.

Abstract Background: There is a lack of studies describing the normal size of the aorta in Mexican population. Objective: To analyze aortic measurements in Mexican patients and to compared them with patients from five different countries. Methods: Measurements of the aorta were divided in Mexicans and controls. Comparisons between ethnicities and groups were performed using Mann Whitney rank sum test. Results: The registry included 166 patients, 106 (63.8%) were enrolled in Mexico and 60 (36.1%) in the control group. Mexican patients had smaller aortic diameters compared to the control group, at the level of the right renal artery ostium, inferior mesenteric artery, and aortic bifurcation. The Hispanic population had significantly smaller aortic diameters from the level of the celiac artery to the aortic bifurcation. Conclusion: The normal aortic diameters in the Mexican population are smaller compared to other countries.

https://doi.org/10.24875/rma.22000026 2 downloads

Discurso presidencial del Congreso Internacional de Angiología, Cirugía Vascular y Endovascular 2021
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Hinojosa, Carlos A.

Revista mexicana de angiología

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mar 2022, Volume 50 N. 1 Pages 1 - 13

Abstract: Es | Text: Es | PDF: Es

https://doi.org/10.24875/rma.21000047 12 downloads

Expression of miR-145, miR-146, and miR-155 in an experimental model of arteriovenous fistula
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Laparra-Escareño, Hugo

; Ortega-Gómez, Alett

; Manzo-Merino, Joaquín

; Zentella-Dehesa, Alejandro

; Bobadilla-Rosado, Luis O.

; Hinojosa, Carlos A.

Revista mexicana de angiología

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mar 2022, Volume 50 N. 1 Pages 26 - 31

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract Background: The arteriovenous fistula (AVF) is the first option as vascular access for patients with end-stage renal disease. The main cause of failure is stenosis of the venous portion of the AVF secondary to intimal hyperplasia. Material and methods: The objective of this study was to evaluate the relative expression of miR-145, miR-146, and miR-155. We used an experimental model of intimal hyperplasia creating an AVF. We included six Wistar Rats. The analysis and validation of miR-145, miR-146, and miR-155 was performed using real-time polymerase chain reaction. Results: There is a down-regulation of miR-145 in the vein (0.233 ± 0.3, p = 0.0030) and artery (0.33 ± 0.4, p = 0.0630), compared to the control. Likewise, we found upregulation of miR-146 in the vein (29 ± 0.25, p = 0.0256) and artery (34.66 ± 0.35, p = 0.0345) compared to the control and upregulation of miR-155 in the vein (20 ± 0.39, p = 0.0231) and artery (22.66 ± 0.49, p = 0.0234) compared to the control. Conclusions: We found alterations in the expression of miR-145, miR-146, and miR-155 comparing the fistula versus control, both in the arterial and venous portions in an experimental model of AVF.

Resumen Antecedentes: La fístula arteriovenosa es la primera opción como acceso vascular para pacientes con enfermedad renal terminal. La principal causa de fracaso es la estenosis de la porción venosa de la fístula secundaria a hiperplasia intimal. Material y métodos: El objetivo de este estudio fue evaluar la expresión relativa de miR-145, miR-146 y miR-155. Utilizamos un modelo experimental de hiperplasia intimal realizando una fístula arteriovenosa. Incluimos 6 ratas Wistar. El análisis y validación de miR-145, miR-146 y miR-155 se realizó mediante reacción en cadena de la polimerasa en tiempo real. Resultados: Hay una regulación a la baja de miR-145 en la vena (0.233 ± 0.3, p = 0.0030) y arteria (0.33 ± 0.4, p = 0.0630), en comparación con el control. Asimismo, encontramos regulación positiva de miR-146 en vena (29 ± 0.25, p = 0.0256) y arteria (34.66 ± 0.35, p = 0.0345) en comparación con el control y regulación positiva de miR-155 en vena (20 ± 0.39, p = 0.0231) y arteria (22.66 ± 0.49, p = 0.0234) en comparación con el control. Conclusiones: Encontramos alteraciones en la expresión de miR-145, miR-146 y miR-155 comparando la fístula vs. control, tanto en la porción arterial como venosa en un modelo experimental de fistula.

https://doi.org/10.24875/rma.22000001 3 downloads

10.

Guía de práctica clínica mexicana para el diagnóstico y tratamiento de las dislipidemias y enfermedad cardiovascular aterosclerótica
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Pavía-López, Abel A.

; Alcocer-Gamba, Marco A.

; Ruiz-Gastelum, Edith D.

; Mayorga-Butrón, José L.

; Mehta, Roopa

; Díaz-Aragón, Filiberto A.

; Aldrete-Velasco, Jorge A.

; López-Juárez, Nitzia

; Cruz-Bautista, Ivette

; Chávez-Mendoza, Adolfo

; Secchi-Nicolás, Nikos C.

; Guerrero-Martínez, Francisco J.

; Cossio-Aranda, Jorge E.

; Mendoza-Zubieta, Victoria

; Fanghänel-Salmon, Guillermo

; Valdivia-Proa, Martha

; Olmos-Domínguez, Luis

; Aguilar-Salinas, Carlos A.

; Dávila-Maldonado, Luis

; Vázquez-Rangel, Armando

; Pavia-Aubry, Vanina

; Nava-Hernández, María de los A.

; Hinojosa-Becerril, Carlos A.

; Anda-Garay, Juan C.

; Ríos-Ibarra, Manuel O. de los

; Berni-Betancourt, Ana C.

; López-Cuellar, Julio

; Araiza-Garaygordobil, Diego

; Rivera-Reyes, Romina

; Borrayo-Sánchez, Gabriela

; Tapia-Hernández, Mónica

; Cano-Nigenda, Claudia V.

; Guerra-López, Arturo

; Elías-López, Josué

; Figueroa-Morales, Marco A.

; Montaño-Velázquez, Bertha B.

; Velasco-Hidalgo, Liliana

; Rodríguez-Lozano, Ana L.

; Pimentel-Hernández, Claudia

; Baquero-Hoyos, María M.

; Romero-Moreno, Felipe

; Rodríguez-Vega, Mario

Archivos de cardiología de México

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2022, Volume 92 Suppl. 1 Pages 1 - 62

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

resumen está disponible en el texto completo

Abstract Background: Cardiovascular diseases are the leading cause of mortality worldwide and Mexico is no exception. The epidemiological data obtained in 1990 showed that cardiovascular diseases represented 19.8% of all causes of death in our country. This figure increased significantly to 25.5% for 2015. Some national surveys suggest that more than 60% of the adult population has at least one risk factor for cardiovascular disease (obesity or overweight, hypertension, smoking, diabetes, dyslipidemias). On the other hand, data from the Pan American Health Organization have linked the process of atherosclerosis as the first cause of premature death, significantly reducing life expectancy, which has enormous social repercussions. Objective: This document constitutes the Clinical Practice Guide (CPG) prepared at the initiative of the Mexican Society of Cardiology in collaboration with the Mexican Society of Nutrition and Endocrinology, AC, National Association of Cardiologists of Mexico, AC, Mexican Association for the Prevention of Atherosclerosis and its Complications, AC, National Normative Committee of General Medicine, AC, National College of Geriatric Medicine, AC, College of Internal Medicine of Mexico, AC, Mexican Society of Angiology and Vascular and Endovenous Surgery, AC, Mexican Institute of Research Nephrological, AC and the Mexican Academy of Neurology, A.C.; with the methodological support of the Ibero-American Agency for the Development and Evaluation of Health Technologies, in order to establish recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. The objective of this document is to provide evidence-based recommendations to help decision makers in the diagnosis and treatment of dyslipidemias in our country. Material and methods: This document complies with international quality standards, such as those described by the Institute of Medicine of the USA, the Institute of Clinical Excellence of Great Britain, the Scottish Intercollegiate Guideline Network and the Guidelines International Network. A multidisciplinary group of clinical experts and methodologists with experience in systematic reviews of the literature and the development of clinical practice guidelines was formed. A scope document was agreed upon, relevant clinical questions were established, the best available evidence critically evaluated in systematic literature reviews was exhaustively identified, and clinical recommendations were developed. The modified Delphi Panel methodology was used to achieve an adequate level of consensus in each of the recommendations contained in this CPG. Results: 23 clinical questions were agreed upon which gave rise to their respective clinical recommendations. Conclusions: We consider that this document contributes to better clinical decision-making and becomes a point of reference for clinicians and patients in the management of dyslipidemias and this contributes to reducing the morbidity and mortality derived from atherosclerotic cardiovascular events in our country.

https://doi.org/10.24875/acm.m22000081 1458 downloads

11.

Mortalidad por aneurismas aórticos en México: necesidad de un registro nacional
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Hinojosa, Carlos A.

; Chiquete, Erwin

; Bobadilla-Rosado, Luis O.

Revista mexicana de angiología

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sep 2021, Volume 49 N. 3 Pages 71 - 73

Abstract: Es | Text: Es | PDF: Es

https://doi.org/10.24875/rma.21000027 48 downloads

12.

Endovascular management of a complex high-flow lower limb arteriovenous malformation: Case report and literature review
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Ornelas-Flores, María C.

; Rojas-Reyna, Guillermo A.

; Hinojosa-Gutiérrez, Carlos G.

; González-de Leo, Stefany

Cirugía y cirujanos

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2021, Volume 89 Suppl. 1 Pages 14 - 19

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract Introduction: Lower limb high-flow arteriovenous malformations (AVM) are a rare pathology with a chronic and progressive evolution. Development in imaging and treatment has helped to improve outcome. Objective: We report a case treated with multi-session endovascular embolization therapy with favorable results. Case report: A 44-year-old man referred with a complex high-flow lower limb AVM, previously treated with covered stents and a bypass. Six endovascular interventions were performed, combining different embolization methods. Conclusion: Endovascular treatment is a safe and effective option for high-flow AVMs. Embolization should be done carefully to prevent complications that could threaten the patient’s limb or life.

Resumen Introducción: Las malformaciones arteriovenosas (MAV) son una patología con un curso crónico y una evolución progresiva. Objetivo: Reportar el caso de una MAV tratada con embolización endovascular en múltiples sesiones con resultados favorables. Reporte de caso: Masculino de 44 años referido con una MAV de alto flujo del miembro pélvico derecho, tratado previamente con un stent recubierto y un bypass. Se realizaron seis sesiones endovasculares combinando diferentes métodos de embolización. Conclusión: El manejo endovascular de las MAV de alto flujo es seguro y efectivo, debe de realizarse cuidadosamente evitando poner en riesgo la extremidad del paciente e incluso la vida.

https://doi.org/10.24875/ciru.20000802 11 downloads

13.

Recomendaciones en el tratamiento de la enfermedad tromboembólica venosa en pacientes con infección por COVID-19
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Morales-Galina, Luis G.

; Bobadilla-Rosado, Luis O.

; Hinojosa, Carlos A.

Revista mexicana de angiología

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sep 2020, Volume 48 N. 3 Pages 70 - 76

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract Since the beginning of the COVID-19 pandemic there has been many reports regarding venous and arterial thrombotic complications in patients infected with the SARS-CoV-2 virus, however the exact mechanisms for patients with COVID-19 to develop hypercoagulability states are still unknown. Prophylactic anticoagulation is considered a fundamental strategy to avoid the aforementioned complications. The objective of the present review is to guide the treatment of thromboembolic venous disease in hospitalized patients infected with SARS-CoV-2. The present article aims to review on specific recommendations of thromboembolic prophylaxis for the treatment of venous thrombotic disease in COVID-19 hospitalized patients. Hence, we differentiate between critically and non-critically ill patients as well as the duration of treatment and the recommended strategies when discharging these patients. There is still uncertainty regarding treatment options for the aforementioned complications, until an effective strategy is found, international recommendations are our best option to follow.

Resumen Desde el inicio de la llamada pandemia por el síndrome respiratorio agudo severo por coronavirus 2 (SARS-CoV-2) se han publicado numerosos reportes de complicaciones tromboembólicas tanto venosas como arteriales en pacientes con enfermedad por coronavirus 2019 (COVID-19). Todavía no se conocen con exactitud los mecanismos a través de los cuales los pacientes desarrollan un estado de hipercoagulabilidad, inclusive con mayor frecuencia que pacientes en las unidades de cuidados intensivos con otro tipo de padecimientos. Una de las estrategias fundamentales para evitar complicaciones en estos pacientes es la profilaxis o tratamiento anticoagulante. El objetivo de este trabajo de investigación consiste en orientar en el tratamiento de la enfermedad tromboembólica venosa en pacientes con COVID-19 hospitalizados. El presente artículo presenta una revisión de los artículos más destacados con recomendaciones específicas tanto para la profilaxis como para el tratamiento de la enfermedad tromboembólica venosa en pacientes con COVID-19, tanto hospitalizados graves como no graves, duración del tratamiento y esquema de medicamentos al egreso hospitalario. Las estrategias de tratamiento para estas complicaciones son aún inciertas, y hasta que no se encuentre una estrategia efectiva para evitarlas, las recomendaciones internacionales son nuestra mejor opción.

https://doi.org/10.24875/rma.20000030 138 downloads

14.

Lesiones urológicas en pacientes sometidas a histerectomía obstétrica por inserción anómala de placenta en un hospital de alta especialidad
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Jiménez-Vieyra, Carlos R.

; Gómez-Suaste, Alicia

; Hinojosa-Cruz, Juan C.

; García-Bello, Juan A.

Cirugía y cirujanos

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aug 2020, Volume 88 N. 4 Pages 473 - 480

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract Objective: To describe frequency and identify risk factors for urological lesions in patients undergoing obstetric hysterectomy secondary to abnormal placental insertion in a high specialty hospital. Material and methods: Transversal, retrospective study of patients underwent hysterectomy due to abnormal placental insertion, from 2017 to 2019; age, obstetric antecedents, comorbidities, type of abnormal placental insertion type of hysterectomy, site of urinary lesion, anesthesia, surgery time and bleeding were studied. Analyses were made with ji square and Kruskal Wallis tests with SPSS V20.0 program considering significative p values p < 0.05. Results: Clinical records of 96 patients with age 32.6 ± 6.1 years were analyzed. Accretism was present in 38.5%, incretism in 19.8% and percretism in 18.8%. Total hysterectomy was accomplished in 78 (81.2%) cases. Urinary lesion was present in 27 (28.1%); vesical in 19 (19.8%), ureteral in 6 (6.5%) and both in 2 (2.0%). Urinary lesion was significantly more frequent in those patients with more pregnancies (median 4 [interquartile range (IQR): 3-4] vs. 3 [2-4]; p= 0.004), more caesarean sections (4 [3-4] vs. 2 [1-3]; p < 0.001), hemorrhage (3000 mL [2000-4800] vs. 2000 mL [1200-3000]; p = 0.001), and more surgery time (3.75 h [3.5-4.0] vs. 3.0 [2.0-3.5]; p < 0.001). Conclusions: Urinary lesions in patients undergoing obstetric hysterectomy secondary to abnormal placental insertion are more frequent with higher number of pregnancies, caesarean sections, hemorrhage and surgery time.

Resumen Objetivo: Identificar los factores de riesgo asociados a lesiones urológicas en pacientes con histerectomía por inserción anómala de placenta. Material y métodos: Estudio transversal, retrospectivo, de pacientes sometidas a histerectomía por inserción anómala de placenta de 2017 a 2019. Se estudiaron edad, antecedentes obstétricos, comorbilidad, tipo de inserción placentaria, tipo de histerectomía, sitio de la lesión urinaria, anestesia, tiempo quirúrgico y sangrado. Se realizaron medidas de tendencia central y dispersión, frecuencias y proporciones. Los análisis se realizaron con las pruebas de ji al cuadrado y de Kruskal Wallis con el programa SPSS V.20.0, considerando significativa p < 0.05. Resultados: Se estudiaron 96 pacientes de 32.6 ± 6.1 años. Tuvieron acretismo el 38.5%, incretismo el 19.8% y percretismo el 18.8%. Se hizo histerectomía total a 78 (81.2%). Presentaron lesión urinaria 27 (28.1%): vesical 19, ureteral 6 y ambas 2. La lesión urinaria fue más frecuente en las pacientes que tuvieron más gestas (4 [rango intercuartílico (RIQ): 3-4] vs. 3 [2-4]; p = 0.004), más cesáreas (4 [3-4] vs. 2 [1-3]; p < 0.001), mayor sangrado (3000 ml [2000-4800] vs. 2000 ml [1200-3000]; p = 0.001) y mayor tiempo quirúrgico (3.75 h [3.5-4.0] vs. 3.0 [2.0-3.5]; p < 0.001). Conclusiones: La lesión urinaria fue más frecuente en las pacientes que tuvieron mayor número de gestas, más cesáreas, más sangrado y mayor tiempo quirúrgico.

https://doi.org/10.24875/ciru.20000117 78 downloads

15.

Estado actual, costos económicos y sociales del pie diabético y las amputaciones en la población mexicana
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Torres-Machorro, Adriana

; Ruben-Castillo, Christopher

; Torres-Roldán, José F.

; Miranda-Gómez, Óscar Francisco

; Catrip-Torres, Jorge

; Hinojosa, Carlos A.

Revista mexicana de angiología

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jun 2020, Volume 48 N. 2 Pages 53 - 64

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract The high costs derived from the diabetes management in industrialized countries ar the result from failure in the disease response process, contrasting with those in developing nations, where late disease treatment increases the costs. The expenses of diabetic foot treatment in Mexico confirm that the health system is deficient. Therefore, efforts should be focused on prevention, since the spending of a patient with well-controlled and uncomplicated diabetes is 8,000 Mexican pesos per year. This sum represents a small amount of money compared to the one of managing a single patient with complications, which may exceed 300,000 Mexican pesos per year or more if amputation is performed. The deleterious effects of the diabetic foot must foster a deep awareness and thereby help to prevent disease’ progression. It is essential to modify the imperfections in medical care and to apply effective prevention strategies, locally and nationally, to reduce the amount of above the knee amputations and lower their burden. Limb loss concerns not only the patient but the patient’s family. In these cases, we all participate directly or indirectly to reintegrate patients into a productive and active life. This task becomes almost impossible once the limb is seriously affected because it irreversibly changes the patient’s environment and the society in which he or she interacts.

Resumen En los países industrializados, los altos costos del tratamiento de la diabetes mellitus derivan de las fallas en el proceso de respuesta a la enfermedad, sin embargo, en naciones emergentes, los elevados costos se asocian principalmente a la atención tardía de los pacientes. Los montos del tratamiento del pie diabético en México corroboran que existe una deficiencia en el sistema de salud. Por ello, los esfuerzos deben enfocarse a la prevención, pues el costo de un paciente con diabetes con buen control y sin complicaciones es de 8,000 pesos mexicanos anuales. Esta suma representa «poco» comparado con el costo del manejo anual de un solo paciente con complicaciones, que puede sobrepasar los 300.000 pesos, o incluso multiplicarse si se realiza una amputación mayor. Se debe fomentar una consciencia profunda de las catastróficas secuelas del pie diabético y, con ello, limitar la progresión de esta enfermedad. Es de extrema importancia modificar las imperfecciones en la atención médica e implementar estrategias preventivas eficaces a nivel local y nacional para minimizar la realización de amputaciones mayores y abatir sus consecuentes costos. La pérdida de una extremidad afecta al paciente y a la familia del enfermo. En estos casos, todos participamos de manera directa o indirecta en la reinserción de los enfermos a la vida productiva o normal, lo cual es imposible de lograr una vez que la extremidad se compromete seriamente, pues se afecta irreversiblemente el entorno del enfermo y a la sociedad en la que se desarrolla.

https://doi.org/10.24875/rma.20000019 1290 downloads

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