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Search Results: 1 - 10 of 8224 matches for " Michel Bergoeing "
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Reparación endovascular de Aneurisma aórtico abdominal: Estudio piloto de endoprótesis Ovation . Resultados comparativos Endovascular repair of abdominal aortic aneurysm: comparative results of a pilot study using the Ovation prosthesis
Francisco Valdés,Renato Mertens,Michel Bergoeing,Leopoldo Mariné
Revista Chilena de Cardiología , 2011,
Abstract: Introducción: Las endoprótesis actuales para tratar aneurismas aórticos (AAA) requieren introductores de alto diámetro (18-25F) y se sustentan excluyendo el aneurisma, mediante la fuerza radial de stents metálicos. Objetivo: prótesis Ovation (TriVascular, EEUU) con aquellas disponibles en el mercado. Material y Método: Entre Noviembre 2009 y Agosto 2010 tratamos 47 AAA. En 10 pacientes usamos Ovation (Grupo 1). Grupo Control (2): diez pacientes tratados contemporáneamente con endoprótesis comerciales. Ovation es tri-modular, de PTFE y nitinol con un stent barbado para fijación supra-renal. Sella bajo las arterias renales mediante 2 anillos llenados con un polímero durante el implante. Usa introductor 13-15F. Usa-Philips-Allura (Best, Holanda). Comparamos: duración del procedimiento, hospitalización y complicaciones. Utilizamos test de Fisher exacto y t de student no pareado. Resultados: éxito técnico 100%. Sin diferencia entre grupos (edad, sexo, tama o AAA, riesgo ASA, laboratorio preoperatorio). Tiempo operatorio (hrs): 2,12 ± 0,7 vs. 2,0 ± 0,6 (NS). Estadía postoperatoria (hrs): 44,5 ± 10,7 vs 49,5 ± 32,0 (NS). El cuello del AAA y la permanencia en UTI fueron más cortos en grupo 1 (p= 0,035 y 0,0451). Seguimiento (4,5-12 meses) sin eventos adversos, endofugas tipo I ni III, ni re-intervenciones. Conclusiones: Los resultados con Ovation a corto plazo son comparables con los de otras endoprótesis, cumpliendo con estándares de eficacia y seguridad. Ovation navega por vasos peque os, permite un despliegue preciso y sellado efectivo en cuellos > 7 mm, ampliando el tratamiento endovascular del AAA. Background. Current endografts used in treatment of abdominal aortic aneurysm (AAA), use large (18-25F) delivery systems. Graft fixation and aneurysm sealing is obtained by a proximal stent, requiring an aortic neck >15 mm. Objective. To compare the efficacy and safety of Ovation endograft (TriVascular, USA) with standard endografts. Methods. Between November 2009 and August 2010 we treated 47 AAA. In 10 patients we used Ovation (Group 1). Ten patients treated during the same period with commercially available endografts were used as controls (Group (2). The Ovation endo-prosthesis is tri-modular, made of PTFE andnitinol with low profile (13-15F) and has a barbed suprarenal stent for fixation. Sealing is obtained independently through 2 inflatable rings filled with a biocompatible polymer during the procedure. Implantation followed the standard procedure through femoral exposure, using the Philips Allura imaging equipment (Best, Netherlands). Procedure d
Enfermedad de Erdheim-Chester. Una causa rara de derrame pericárdico: Caso clínico Erdhei-Chester disease: Report of one case
Jorge Vega,Marcela Cisternas,Michel Bergoeing,Roberto Espinosa
Revista médica de Chile , 2011,
Abstract: We report a 76-year-old male who was admitted due to progressive congestive heart failure lasting several months. An echocardiogram showed a large pericardial effusion with early signs of pericardial tamponade and an irregular surface suggestive of cancer infiltration. The patient was operated, creating a pericardial window and draining 1,200 ml of a brownish yellow fluid with abundant cellularity. Pericardial biopsy showed infiltration by CD68 (+), CD1a (-) and S100 (-) cells. Twenty-eight months earlier, due to fatigue, dyspnea, and a non-specific inflammatory process, an enhanced-contrast-scan showed that aorta was coated with a hypodense tissue that began near the aortic valve and extended until the inferior mesenteric artery, with stenosis of the left subclavian, celiac axis, renal and upper mesenteric arteries. An angioplasty and stent placing was carried out in the last two arteries. Both kidneys had the appearance of "hairy kidneys". A bone scan showed increased uptake in femurs and tibiae and X-ray examination showed osteosclerosis in metaphysis and diaphysis. The diagnosis of Erdheim-Chester disease (non-Langerhans-cell histiocytosis) was made and the patient was treated with steroids and methotrexate.
Enfermedad de Erdheim-Chester. Una causa rara de derrame pericárdico: Caso clínico
Vega,Jorge; Cisternas,Marcela; Bergoeing,Michel; Espinosa,Roberto; Zapico,Alvaro; Chadid,Pedro; Santamarina,Mario;
Revista médica de Chile , 2011, DOI: 10.4067/S0034-98872011000800011
Abstract: we report a 76-year-old male who was admitted due to progressive congestive heart failure lasting several months. an echocardiogram showed a large pericardial effusion with early signs of pericardial tamponade and an irregular surface suggestive of cancer infiltration. the patient was operated, creating a pericardial window and draining 1,200 ml of a brownish yellow fluid with abundant cellularity. pericardial biopsy showed infiltration by cd68 (+), cd1a (-) and s100 (-) cells. twenty-eight months earlier, due to fatigue, dyspnea, and a non-specific inflammatory process, an enhanced-contrast-scan showed that aorta was coated with a hypodense tissue that began near the aortic valve and extended until the inferior mesenteric artery, with stenosis of the left subclavian, celiac axis, renal and upper mesenteric arteries. an angioplasty and stent placing was carried out in the last two arteries. both kidneys had the appearance of "hairy kidneys". a bone scan showed increased uptake in femurs and tibiae and x-ray examination showed osteosclerosis in metaphysis and diaphysis. the diagnosis of erdheim-chester disease (non-langerhans-cell histiocytosis) was made and the patient was treated with steroids and methotrexate.
Uso de endoprótesis fenestrada para la reparación de aneurismas aórticos complejos: Reporte de dos casos Fenestrated endografts for the treatment of complex aortic aneurysms: Report of two cases
MICHEL BERGOEING R,RENATO MERTENS M,FRANCISCO VALDéS E,LEOPOLDO MARINé M
Revista Chilena de Cirugía , 2011,
Abstract: La reparación endovascular de un aneurisma aórtico abdominal infrarrenal (EVAR) se ha popularizado en la última década. Sin embargo, hasta ahora los pacientes con aneurisma aórtico abdominal yuxtarrenal (AAAY) o aneurisma aórtico tóracoabdominal (AATA) no eran candidatos a EVAR por ausencia de una zona sana donde apoyar la endoprótesis tubular. La reparación convencional se asocia a una morbimortalidad considerable, por lo que se han desarrollado endoprótesis capaces de acomodar ramas de la aorta que permiten tratar estos aneurismas en forma mínimamente invasiva. Presentamos la experiencia inicial de dos casos, ambos de sexo masculino y portadores de enfermedad coronaria considerados de alto riesgo para cirugía abierta. El primero, portador de un AAAY sacular de 4,1 cm de diámetro; se repara mediante el uso de endoprótesis fenestrada con ramas a ambas arterias renales (AR), arteria mesentérica superior (AMS) y una escotadura para el tronco celíaco (TC). El otro, portador de AATA de 5,9 cm de diámetro, un puente aorto bifemoral previo y TC crónicamente ocluido; se repara con endoprótesis fenestrada con ramas para las AR y AMS. Ambos pacientes presentaron una evolución post operatoria favorable. El seguimiento a 11 meses para el primero y 30 días para el segundo demuestra exclusión del aneurisma y permeabilidad de todas las arterias revasculari-zadas. Este nuevo procedimiento terapéutico abre la posibilidad de tratar pacientes de alto riesgo, portadores de aneurismas aórticos complejos, para los que una alternativa convencional implica un alto riesgo quirúrgico. In the last decade endovascular repair of infrarenal aortic aneurysms (EVAR) has become increasingly popular. However, until recently patients with juxtarenal abdominal aortic aneurysms (JAAA) or with thoracoabdominal aortic aneurysms (TAA) were not candidates for EVAR due to the lack of an adequate landing zone to deploy the endograft. Because of considerable morbidity and mortality that traditional open surgery of these aneurysms entail, new endografts with fenestrations and branches have been developed to treat these patients. We present our initial experience with two cases, both male with coronary artery disease considered high-risk for traditional open repair. The first patient has a 4.1 cm sacular JAAA; it is repaired with a fenestrated endograft with branches for both renal arteries (RA), superior mesenteric artery (SMA) and a scallop for the celiac trunk (CT). The second patient has a 5.9 cm TAA with a previous aorto bifemoral bypass; because the CT is chronically occluded it is repaired
Tratamiento endovascular de lesiones traumáticas de troncos supra aórticos Endovascular treatment of traumatic supra aortic trunk lesions
MICHEL BERGOEING R,RENATO MERTENS M,LEOPOLDO MARINé M,FRANCISCO VALDéS E
Revista Chilena de Cirugía , 2011,
Abstract: Introducción: Las lesiones traumáticas de troncos supra aórticos (TSA) tienen elevada morbimor-talidad, y su tratamiento presenta un desafío técnico. Las técnicas endovasculares se presentan como una alternativa atractiva y de menor riesgo para su solución efectiva. Objetivos: Evaluar los resultados del tratamiento endovascular de las lesiones de TSA. Material y Método: Se revisaron retrospectivamente todos los pacientes sometidos a tratamiento endovascular de lesiones de TSA. Resultados: Entre Marzo de 2000 y Agosto de 2009 se intervinieron 8 pacientes, 6 hombres, edad promedio 33,6 a os. El mecanismo traumático fue contuso en 3 y penetrante en 5. Los vasos afectados fueron arteria subclavia en 5, tronco braquiocefálico en 2 y carótida común en uno. De los pacientes con lesión subclavia, tres presentaron compromiso de plexo braquial asociado. Siete pacientes fueron tratados con implante de endoprótesis y uno mediante embolización. Un paciente requirió un stent no cubierto para tratar el colapso parcial precoz de una endoprótesis. No hubo morbilidad neurológica de novo ni mortalidad operatoria. El seguimiento clínico promedio es 24,3 meses. Dos pacientes se perdieron al seguimiento. La permeabilidad primaria asistida es 100% a 21,9 meses. Conclusiones: El tratamiento endovascular de lesiones de TSA es efectivo, con baja morbimortalidad y con buena permeabilidad a mediano plazo. Introduction: Traumatic lesions of supra aortic trunks (SAT) have an elevated morbidity and mortality, and its treatment is technically challenging. Endovascular techniques offer an effective solution with a lower risk, making it an attractive alternative. Objectives: Retrospective review of all the patients with SAT lesions treated with endovascular techniques. Results: Between March 2000 to August 2009, 8 patients were treated, 6 men, mean age 33.6 years. Three patients suffered blunt and 5 a penetrating trauma. The injured vessels were subclavian artery in 5, brachiocephalic trunk in two and common carotid in one. Of the 5 patients with subclavian artery injury, three had associated brachial plexus injury. Six patients were treated with an endo-graft and one with coil-embolization. One patient suffered an early partial collapse of his endograft, requiring an additional bare metal stent to maintain patency. In this series there was neither neurological morbidity nor operative mortality. Follow-up is 24.3 months, and primary assisted patency is 100% at 21.9 months with two patients lost to follow-up. Conclusions: Endovascular treatment of SAT lesions is effective, showing low mo
Tratamiento híbrido de arteria subclavia derecha aberrante Hybrid treatment aberrant right subclavian artery
Francisco Vargas S,Renato Mertens M,Gonzalo Sánchez C,Michel Bergoeing R
Revista Chilena de Cirugía , 2013,
Abstract: Introducción: La arteria subclavia derecha aberrante es la malformación arterial más frecuente del arco aórtico. Su diagnóstico es habitualmente un hallazgo de estudios de imágenes solicitados por otras causas pero puede tener serias complicaciones si se obtiene en forma tardía. Caso clínico: Presentamos el caso de una mujer joven con diagnóstico de arteria subclavia lusoria dilatada sometida exitosamente a tratamiento híbrido electivo. Introduction: An aberrant right subclavian artery is the most frequent aortic arch malformation. It is frequently an incidental finding of imaging studies and serious complications may arise if left untreated. Clinical case: We present a case of a young woman with a dilated aberrant right subclavian artery that was successfully treated by a hybrid approach.
Tratamiento endovascular del trauma de aorta descendente Endovascular treatment of descending aorta trauma
Renato Mertens M,Francisco Valdés E,Albrecht Kr?mer Sch,Michel Bergoeing R
Revista médica de Chile , 2005,
Abstract: Background: Mortality of traumatic aortic lesions is over 80%. A group of those who survive, develop a chronic pseudo aneurism, usually asymptomatic, that is detected during imaging studies. Since conventional surgical treatment of traumatic aortic lesions has a great mortality, endovascular treatment has been used as an alternative treatment in the last decade. Aim: To report our experience with endovascular treatment of traumatic aortic lesions. Patients and methods: Report of seven patients aged 22 to 65 years, with traumatic aortic lesions. Under general anesthesia an endovascular prosthesis was inserted through the femoral artery. Results: No complications were observed in the postoperative period, and after a follow up ranging from 4 to 40 months, no endoleaks or other complications have been detected. Conclusions: Endovascular treatment of traumatic aortic lesions has good immediate and midterm results
Tratamiento endovascular del síndrome de vena cava superior Endovascular treatment of superior vena cava syndrome
Michel Bergoeing R,Renato Mertens M,Francisco Valdés E,Albrecht Kr?mer Sch
Revista médica de Chile , 2006,
Abstract: Background: Superior vena cava syndrome (SVCS) is caused by the obstruction of venous drainage from the upper portion of the body. Common clinical findings are headache and cervical, facial and upper limb edema. Occasionally, clouding of consciousness appears. Aim: to report our experience with endovascular treatment of SVCS. Material and methods: Retrospective review of all patients with SVCS subjected to endovascular treatment between 1999 and 2005. Results: Eight patients were treated, all of them with malignancies. Six had a benign obstruction due to the presence of a chemotherapy catheter located in the superior vena cava, one had obstruction secondary to radiation therapy and one a tumor compression of the superior vena cava. Two patients underwent thrombolytic therapy. Angioplasty and stenting was performed in all patients. The chemotherapy catheter was removed to all patients and installed again in one. One patient had a hemothorax secondary to a simultaneous needle lung biopsy under video thoracoscopy. No patient died in relation to the procedure. Congestive signs and symptoms subsided in all patients within 24 hours after the procedure. During follow up, only one patient had symptoms related to vena cava obstruction and three died due to their malignant tumor. Conclusions: Endovascular treatment of SVCS has a low rate of complications and provides immediate and mid-term symptom relief
Tratamiento endovascular de aneurisma aórtico abdominal: resultados en 80 pacientes consecutivos Endovascular repair of abdominal aortic aneurysm: Results in 80 consecutive patients
Francisco Valdés E,Renato Mertens M,Albrecht Kr?mer Sch,Michel Bergoeing R
Revista médica de Chile , 2006,
Abstract: Background: Endovascular repair of abdominal aortic aneurysms (AAA) avoids laparotomy, shortens hospital stay and reduces morbidity and mortality related to surgical repair, allowing full patient recovery in less time. Aim: To report short and long term results of endovascular repair of AAA in 80 consecutive patients treated at our institution. Patients and Methods: Between September 1997 and February 2005, three women and 77 men with a mean age 73.6±7.7 years with AAA 5.8±1.0 cm in diameter, were treated. The surgical risk of 38% of patients was grade III according to the American Society of Anesthesiologists classification. Each procedure was performed in the operating room, under local or regional anesthesia, with the aid of digital substraction angiography. The endograft was deployed through the femoral artery (83.7% bifurcated, 16.3% tubular graft). A femoro-femoral bypass was required in 11.3% of cases. Follow-up included a spiral CT scan at 1, 6 and 12 months postoperatively, and then annually. Results: Endovascular repair was successfully completed in 79/80 patients (98.7% technical success). The procedures lasted 147±71 min. Length of stay in the observation unit was 20.6±13.5 h. Blood transfusion was required in 10%. Sixty two percent of the patients were discharged before 72 h. One patient died 8 days after surgery due to a myocardial infarction (1.3%). During follow-up (3-90 months), 1 patient developed late AAA enlargement due to a type I endoleak, requiring a new endograft. No AAA rupture was observed. Survival at 4 years was 84.2% (SE =9.2). Endovascular re-intervention free survival was 82.7% (SE =9.5). Conclusion: Endovascular surgery allows effective exclusion of AAA avoiding progressive enlargement and/or rupture and is a good alternative to open repair. Close and frequent postoperative follow up is mandatory
Aneurisma aórtico abdominal en pacientes mayores de 80 a os: tratamiento quirúrgico convencional en 80 casos consecutivos Results of the surgical management of abdominal aortic aneurysms in 80 patients over 80 years of age
Francisco Valdés E,Michel Bergoeing R,Albrecht Kr?mer Sch,Renato Mertens M
Revista médica de Chile , 2003,
Abstract: Abdominal aortic aneurysms (AAA) may be lethal unless appropriately and timely treated. Since age is a surgical risk, octogenarians are usually not considered as candidates for surgical intervention. Aim: To asses surgical complications and mortality in octogenarians treated for AAA. Subjects and Methods: Patients aged 80 years older, treated consecutively between 1984-2001 were retrospectively analyzed. Results: Sixty one patients were male, and their age ranged from 80 to 95 years. All were treated with open surgery. The operation was elective in 58 and as an emergency in 22 patients (symptomatic or ruptured AAA). Aortic diameter was 6.8±1.4 cm in asymptomatic patients and 7.7±1.8 cm in emergency cases (p=0.024). Thirty days postoperative mortality was 5.1% in elective surgery compared to 40.6% in emergency operations (p <0.01). Five years survival rate was 44.7% in asymptomatic patients compared to 10.4% in the emergency cases (p <0.023). Conclusions: Elective surgery for asymptomatic AAA can be performed with low operative mortality in octogenarians. However, surgery in emergency cases has an 8 fold increase in risk. Accordingly, octogenarian patients should be considered for elective AAA repair in a selective basis
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