Publications by authors named "Milagros Marini"

Objectives: The objective of this study is to compare early and long-term results in terms of survival and aortic complications for traumatic aortic injuries depending on the initial management strategy.

Methods: From January 1980 to January 2017, 101 patients with aortic injuries were divided into 3 groups according to management strategy at admission: 60 patients, conservative management; 26 patients, open surgery and 15 patients, endovascular repair. The groups were similar in terms of gender and trauma severity scores.

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One of the most feared complications of thoracic endovascular aortic repair (TEVAR) and hybrid arch repair is retrograde type A aortic dissection (RTAD). More than two-thirds of RTAD occurs in the immediate postoperative period and first postoperative month. In presentations beyond that point, progression of the native aortopathy must be considered.

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Objective: Aortoesophageal and aortobronchial fistulas are uncommon but life-threatening conditions. The present study aimed to identify potential differences in outcomes, depending on the etiology, type, and management of the fistulas, and to determine mortality predictors.

Methods: We retrospectively reviewed a series of 26 consecutive patients with thoracic aorta fistulas admitted to our institution from 1998 to 2013 (18 aortobronchial, 7 aortoesophageal, and 1 combined fistula).

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We report an endovascular technique for the treatment of large neck pulmonary artery aneurysms. This technique consists of the synchronized parallel deployment of two vascular plugs.

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Objective: To report the clinical and radiological characteristics, management and outcomes of traumatic ascending aorta and aortic arch injuries.

Methods: Historic cohort multicentre study including 17 major trauma patients with traumatic aortic injury from January 2000 to January 2011.

Results: The most common mechanism of blunt trauma was motor-vehicle crash (47%) followed by motorcycle crash (41%).

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Purpose: To develop a risk score based on physical examination and chest X-ray findings to rapidly identify major trauma patients at risk of acute traumatic aortic injury (ATAI).

Methods: A multicenter retrospective study was conducted with 640 major trauma patients with associated blunt chest trauma classified into ATAI (aortic injury) and NATAI (no aortic injury) groups. The score data set included 76 consecutive ATAI and 304 NATAI patients from a single center, whereas the validation data set included 52 consecutive ATAI and 208 NATAI patients from three independent institutions.

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OBJECTIVE Minimal aortic injuries (MAIs) are being recognized more frequently due to the increasing use of high-resolution diagnostic techniques. The objective of this case series review was to report the clinical and radiological characteristics and outcomes of a series of patients with MAI. METHODS From January 2000 to December 2011, 54 major blunt trauma patients were admitted to our institution with traumatic aortic injuries.

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Background: The objectives of this study were to report the clinical and radiological characteristics and outcomes of a series of acute traumatic aortic injuries (ATAIs) with associated injury to major aortic abdominal visceral branches (MAAVBs).

Methods: From January 2000 to August 2011, 10 consecutive major blunt trauma patients with associated ATAI and injury to MAAVBs (group A) and 42 major blunt trauma patients presenting only an ATAI without MAAVB injuries (group B) were admitted to our institution.

Results: Overall in-hospital mortality was 32.

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Background: The objective of this study is to report the clinical and radiological characteristics and early and long-term survival of a series of acute traumatic aortic injuries (ATAI) in crush trauma patients, and to compare such data with our last 30 years experience managing ATAI in deceleration non-crush trauma patients.

Methods: From January 1980 to December 2010, 5 consecutive ATAI in crush trauma and 69 in non-crush trauma patients were admitted at our institution. ISS, RTS and TRISS scores were similar in both groups.

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Objective: The purpose of this study is to compare early and long-term results in terms of survival and cardiovascular complications of patients with acute traumatic aortic injury who were conservatively managed with patients who underwent surgical or endovascular repair.

Methods: From January 1980 to December 2009, 66 patients with acute traumatic aortic injury were divided into 3 groups according to treatment intention at admission: 37 patients in a conservative group, 22 patients in a surgical group, and 7 patients in an endovascular group. Groups were similar with regard to gender, age, Injury Severity Score, Revised Trauma Score, and Trauma Injury Severity Score.

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Type III endoleaks, which may be caused by endograft disconnection, pose the risk of aneurysm enlargement and rupture because the pressure in the aneurysmatic sac tends to equal the systolic aortic pressure. We report the endovascular treatment of a critical dislocation of two thoracic aorta endografts with subsequent massive aneurysmatic pressurization of the aneurysmatic sac, which led to its impending rupture. The aberrant migration of both endografts required a combined, right humeral and left femoral, approach to capture the guide wire with an endovascular snare in the aneurismal sac.

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Between May 2001 and June 2008, the outcome and morphological changes in thoracic aortic lesions of 20 surgical high-risk patients who underwent TEVAR were evaluated. Aortic lesions included 8 (40%) type B dissections, 5 (25%) atherosclerotic aneurysms, 4 (20%) penetrating ulcers and 3 (15%) traumatic aortic ruptures. All patients were classified as American Society of Anaesthesiologists class IV and obtained high scores in both the logistic European System for Cardiac Operative Risk Evaluation, median of 14.

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This report describes the feasibility of combined surgical and endovascular repair of extensive pathologies of the aorta with a specially hybrid procedure. An ascending aorta and proximal aortic arch aneurysm, involving the origin of the innominate artery, and a descending thoracic aorta aneurysm were simultaneously repaired in a 65-year-old man. The ascending aorta, proximal arch, and the origin of the innominate artery were replaced by Dacron grafts (InterVascular, Datascope, La Ciotat, France) under circulatory arrest and deep hypothermia.

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Thrombus formation can be a significant cause for morbidity and mortality after Fontan operation. Intracardiac thrombus formation can lead to chronic pulmonary embolic disease if formed on the right side, or stroke, if on the left side of the heart. Right-sided embolism may result in ventilation/perfusion mismatch or elevation of pulmonary vascular resistance, both of which may seriously hamper cavopulmonary physiology.

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Background: There are unresolved issues regarding the security of liver transplantation with non-heart-beating donors (NHBDs). Recently, an increased incidence of biliary complications, mainly intrahepatic ischemic-type biliary strictures, has been described after controlled NHBDs.

Methods: We studied the incidence and risk factors for biliary complications among uncontrolled NHBDs recipients compared with a large population of HBD recipients.

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Extensive splanchnic venous thrombosis in patients undergoing orthotopic liver transplantation (OLT) continues to have a substantial impact on surgical complexity and perioperative morbidity and mortality rates. This report presents an experience in eight patients with splanchnic venous thrombosis treated by means of splanchnic vessel recanalization, primary stent placement, and closure of spontaneous competitive shunts during OLT. In all cases, portal perfusion in the allograft was adequate, portal hypertension was solved, and no complications were observed.

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In recent years, portal arterialization has been used in liver transplantation to increase the portal flow, as a solution for singular technical problems. We have developed a new auxiliary liver transplantation model in the rat with portal arterialization, so the native hepatic hilium remains untouched, consisting on a graft with a previous 70% hepatectomy. It is sited on the right renal bed, joining the infrahepatic inferior vena cava (IVC) of the graft with the recipient IVC.

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