ᗰIGᑌEᒪ ᗰOᑎTEᖇO-ᗷᗩKEᖇ
@monteromiguel
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Vascular Surgeon - HOPE Vascular & Podiatry. Foot arterialization. CEO OUS product accelerator https://t.co/H1h3f253oF. Co-host @vascularpodcast
Houston, TX
Joined October 2009
Id advise deploying the stent a little higher up to cover the entire dissection flap. (anonymous artist) @hendolat @VEITHsymposium @VIVAPhysicians @LINCmeeting @TCTMD @AMPSymposium
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We should no longer call patients with severe calcification patterns of the foot vessels “no-option patients”. Proud to be part of the team that pushed this project forward. Together we can minimize the burden of major amputations and improve quality of life. Read and share. 🙏.
Transcatheter arterialization of deep veins resulted in 6-month amputation-free survival in 66.1% of 105 patients with chronic limb-threatening ischemia and no conventional options for treatment. Full results of PROMISE II study: #cardiology
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One of the lowest and most unprofessional days of our lives. yes we’re both in healthcare and yes there’s liquor in the coconuts. Sorry @JVascSurg, pls give us the moral compass we desperately need. #retractitnow #MedBikini
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A new level of love for ultrasound is meeting your kiddo for the first time! We love you Lucas Oliver Montero! Keep up the good work buddy! We’re waiting eagerly to meet you soon! 💕 @JennaWMontero
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CLTI arterializations should be left alone for a minimum of 6-8 weeks before any Podiatric intervention. The only 2 drivers for early pod intervention are pain or infection, in which case we like keeping the met cartilage as a protector barrier against osteo. Thoughts on this?
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Ultrasound guided lateral plantar venous access is not impossible. I recommend a torniquete at the ankle level and the probe in longitudinal view. Thanks @JillSommerset for capturing the moment. @hendolat @VascularSVS @VIVAPhysicians @LINCmeeting @AMPSymposium @DeBakeyCVedu
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Our work on venous foot arterialization is now on @JVascSurg. Can’t thank all the authors & patients enough for their commitment to responsible science. We haven’t figured it all out, but we firmly believe there is a role for this in selected patients. 🙏
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Now that’s a cowboy move!!!! 🤩.
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Morning rant: I pity professionals that don’t ask for help or accept lack of knowledge. I can’t tell you how many times at a mature stage of my profesional life I’ve said: IDK, teach me or help me. Being board certified is not a license for careless care. Keep learning always! :).
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Complex PAD case w/CTO from mid SFA to mid Peroneal. No GSV. After discussion with pt, gave endo a shot. Antegrade CFA & retro Peroneal access, all subintimal. Placed 5/150, 6/150 Biomimics from TPT up distal SFA with mid SFA Eluvia 6/120. Thoughts on care and bent knee angio?
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My dream: build the most comprehensive diabetic foot limb salvage unit globally. From A to Z, evrthng people may need. Solid diagnsis, treatmnt & rehab to regain health. If you’re listening and this resonates at a personal or humanitarian level, DM me, let’s build this dream!.
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Very proud of obtaining outstanding faculty member award 4 years in a row @BCM_Surgery + my @TheEmmys award for best instructional #PBShealth @NewsHour show award. Thankful for everyone along the way that has helped me achieve such honorable decorations @jmills1955 @DrRosengart
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Why do people keep using kerlix wrap for diabetic foot wound care? Swelling is a dynamic thing! What’s loose today is super tight tomorrow. Is there anything we can do to black box the use of this product for DF wound care? Does anyone feel this strongly?
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🦶 A regular day at #HOPE limb preservation center. Rocket science in Houston has many shapes and forms. This is ours. @thetoedoctor @NASA @SpaceX #MedTwitter
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Second dose done! Absolutely no reaction whatsoever with the first dose. Ready to take care of my patients! Feeling blessed, strong and mentally healthy! Special thanks to @TexasChildrens for providing them to us. #virusfree2021 @BCM_Surgery @BCMHouston_News @hendolat
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A day for the books… made it back home to Costa Rica to visit my dad, enjoy our baby shower, eat some #gallopinto and on top watch Costa Rica win in the World Cup!
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The only way to avoid ever having complications is to stop doing procedures.
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How to manage post endoDVA foot with bad forefoot wound: 1. Sit on it 6 weeks min (unless infection or severe pain) 2. GuillotineTMA + dermal substitute + VAC 3. STSG. No offloading needed, rehab day 1. Oh and lastly, team approach! @thetoedoctor - see our latest masterpiece! 🦶
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One of the most satisfying feelings ever: the day your patient’s feet are ready for a skin graft. Both already walking. One small step more to leg preservation! #HOPE #HOPEstory #gTMA #arterialization #TADV #eDVA #HYSA @thetoedoctor @hendolat 🦵
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#iHENDOLAT day 1 - The ultimate #toeandflow panel of experts! Wow, thank you guys for helping me through this complex BTK case today! Blessings from HTX. @JillSommerset @thetoedoctor @PalenaMariano @lucasferrermd #Morelli #Quiros @BCM_Surgery @bcmhouston #CMEduringCOVID
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No option CLTI offered a BKA. 7/1 eDVA .8/1 gTMA + skin sub.9/20 STSG.10/1 all healed up and walking. Time from diagnosis to complete healing 90 days (this happens to be the mode in our group). @thetoedoctor @JillSommerset @vascularpodcast . #HOPE
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Venous CTOs are so challenging - fibrotic tissue certainly puts up a fight. Case below: L Innominate vein occlusion secondary to previous indwelling catheters. I love the #Astato30 0.018 to get through. @AIU_Medical @Asahi_Intecc_EU What’s your guide wire of choice? @hendolat
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S/p #arterialization and TMA 2 years ago of the right leg. Fully rehab and in remission. CLTI free survival 24 months and counting. There’s always #HOPE. @thetoedoctor
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#HOPE - our new offices are now open in the down town Texas Medical Center area. @thetoedoctor @JillSommerset @texmed
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Merry Christmas and blessings from the Montero crew (USA + Costa Rica)! 🙏
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I’m constantly in awe that some of us keep making this “no incisions” a trademark of quality. Trust me, I fix over 80% of my cases with perc techniqs. Why demonize a scalpel? Incisions have and will be the most amazing way of caring for many pathologic states. #droptheshade.
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My own claim to fame. MB sweat classification, usually relates to case complexity: 1. Arm pits 2. Arm pits+under boob 3. Down the the bottom of the shirt 4. Down to the pants. SEE below a level 4 case. @Gatorade how bout we get healthcare spokespeople instead of only athletes!?
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The value of bent-knee angiogram should not be underestimated. See attached case. Purposely did hybrid: AKA PTFE BP followed by ENDO for P2 short highly Ca++ CTO. Thought I was done, but after #BentKneeAngio it was obvious I needed addtl stent > far better angio result. Thoughts?
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HYSA leads to granulation at least 2X faster than eDVA.
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New nomenclature for CLTI. I usually call it transportation (macro) and distribution (micro) disease. Tdy Prof Ferraresi discussing same issues, calling it BAD (big artery disease) and SAD (small artery disease). Simple words drive adoption, I’ll move to adopt SAD/BAD from now on
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Always nice to see a healed patient s/p multilevel arterial intervention (ATA: retro crossing, #rotablator and 3.5/220 POBA), followed by beautiful foot scaping by my toemigo Dr Lepow (@thetoedoctor) #STEP #BCMVascular #somosHENDOLAT #AmputationPrevention
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This is probably one of the most mismanaged industry sponsored accounts I’ve seen in a long time. Constantly posting cases with questionable indication and making assumptions of success that are so far from any serious performance goals. Nothing against the MDs here to be clear.
The pre & post images say it all! Dr Paul Foley, vascular surgeon at @DoylestownHlth, shocked the rock in an SFA calcified occlusion. He pre-dilated, used 6.0mm #ShockwaveM5Plus, finished with a 6.0 stent & post-dilated for a great result. US Rx only. ISI
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Nothing like bringing together global leaders to further our knowledge in limb preservation strategies. #hendosyn #clinicalresearch #newdevices #chiapas #preFDA @hendolat @JillSommerset @antoniomunoa
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Dinner for 2 (ok, 5 if you include the pups). camping at our temporary place hoping for a speedy return to normality and a move back to our proper house. Stay warm Texas!
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30 seconds of mental health. wishing you all a healthy 2021! From my homeland to yours. @hendolat @BCM_Surgery
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It’s been a phenomenal ride! Shout out to the most amazing staff one could ever wish for! To the ever magical and welcoming #roomeight
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One clinic day over 10 cases booked. The pandemia is undeniable. Patient/provider awareness levels are low and expectations of care skewed. Education continues to be of essence. Keep at it friends! #STEP #BCMVascular #somosHENDOLAT @BCM_Surgery
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78yo m. Hx of recent MI s/p crnary stenting, hyperlip and smoking (not active). Consult for W3I3FI1. Angio by cards occl CFA/ProxSFA/Profunda. Endo options available yet risky with current anatomy. Open endart w/bovine per patch + Sart flap. Found plaque + acute & chronic clot.
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Joining the @MethodistHosp family earlier this year was a dream come true. Like any leadership position it demands attention and time. For unforeseen family/personal reasons which demand more schedule flexibility, I have elected to step down. New project coming soon @OEISociety.
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77yo male. Admitted for MI and heart failure. Underwent emergent CABG with slow ICU recovery. Bad PAD which in the setting of pressors > bilat forefoot gangrene. After 2 Vasc interventions on each side and 6 Podiatric surgeries by @thetoedoctor . #toeflowANDgo
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Talk to the PIs of @BEST_CLI. The study mostly lead to increased collaboration across different groups. Let’s work together. Let’s refocus on the science.
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@LorenzoPatrone3 @t_intheleadcoat @kmadass @AmputationSuck @farkomd @SDhandMD @drsavealimb @FadiSaab17 @HadyLichaaMD @JayMathewsMD @DGArmstrong @dr_ashishg @jmills1955 @Mustapja @JRUNMD @dandu_n @keithppereira @SIRspecialists @SriniTummala @JillSommerset Pedal loop interventions are over rated and abused. I’ve seen more trashed feet than happy endings when inexperienced operators decide everyone needs a loopplasty.
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Very honored to be sharing, amongst other topics, advanced ultrasound techniques with the Society of Vascular Surgery of Chile. Thank you for the invite! #HOPEglobal
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50yo female, long-standing hx of DM2. HbA1c 16.6%. Admitted for foot infection. WIFI 2-1-2. Source controlled by @thetoedoctor who reports “minimal bleeding” intraop. Attached: foot, pre-xray, non invasive and angio. Any vascular intervention required? If so, why would you?
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Long SFA-pop stent in 2019. Stopped DAPT 2 months ago which lead to severe rest pain. Found occluded stents from ostial SFA down to Pop2. No conduit. High periop cardiac risk. Cleared with #Rotarex 6F x2 passes. What’s your tool of choice for this sort of in-stent occlusion?
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Exciting times. Looking forward to collaborating with a phenomenal team of caregivers at @MethodistHosp. Today did a quick tour and took some headshots. The west campus is beautiful and very well-equipped. @hendolat @TXMedCenter
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A dream come true - State of the art outpatient diabetic foot wound care, limb preservation and education facility in the heart of the @TXMedCenter @hendolat.
Congratulations @monteromiguel and HOPE Vascular & Podiatry Innovation Center on their first broadcast from their beautiful new OBL and clinic.
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WIFI 2 - ischemic 1st toe small ulcer w/High MAC score or SAD dz. Endo attempt, open bypass, ENDO arterialization or OPEN arterialization? Please explain your reasoning if you have an opinion…
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#HOPE #TOEandFLOW W2I3FI2 No Option CLTI s/p open hybrid superficial arterialization based on preop scan by @JillSommerset. I was placing a closure device and @thetoedoctor was immediately performing infection source control @hendolat @VascularSVS
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Fresh off the press. Our #HOPE team was invited to put together a step by step review of arterialization techniques. Open and endo are complimentary and each have their place. Read and share 🙏 @JillSommerset @mattsmeds @hendolat @Vascupedia_com.
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81 yo with W1I3FI0, hx of endart, followed by fem pop. BPG occluded, CFA occluded, SFA occluded. TBI 0.15. Redo redo groin or bypass vs endo CFA plasty? I decided to get the profunda back in play, can always bypass to BK pop from the profunda - thoughts?@BCM_Surgery @hendolat
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Atheroembolic events are a consequence of many, if not all, atherectomy devices. Share your tips and tricks to avoid this dreadful complication. A simple one is to use distal filters. #BCMVascular #STEP #amputationprevention @BCM_Surgery
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Full house at the inaugural Complex Intervention Skills Course by @VascularSVS - DAY 1 Didactics, DAY 2 Hands-on cadaver lab.
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96 yo patient s/p 2 years of multilevel endo revasc + bilateral podiatric procedures. Walks into clinic and charms all staff! Nothing satisfies me more than having patients that are ‘in remission’ (from CLTI) and living their lives. @BCM_Surgery
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As promised. Here’s 5 months of work. FLOW: S/p endo SFA and PTA/plantar angioplasty (x2). TOE: hemicalcanectomy, TMA and STSG to medial aspect. GO: date with prosthetics team in 1 month to initiate rehab at TIRR. #ToeFlowAndGo #BCMVadcular #STEPprogram #somosHENDOLAT
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Some random thoughts on below the ankle interventions expressed during #amp Europe this past week. Very little data and weak performance goals. What little data there is comes from single site experience. Poor wound-related or QOL end-points. Lots of work needed! #somosHENDOLAT
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What prevents diabetic foot minor amputations the most?.
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CLTI patients keep flooding our hospitals. @MedicareGov we need centers of excellence to responsibly care for these patients found hostage to fractured care models, politics and turf wars. #HOPE #HOPEhtx #HOPEglobal #multidisciplinarycare #toeandflow
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Another incredible day at @MethodistHosp WEST hospital. Special celebration with a great sushi display for doctor’s day, followed by a complex IVC filter removal and endo-reconstruction of a chronically occluded iliac vein with @trisharoymd. @DeBakeyCVedu @hendolat #MRIresearch
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Desert foot, renal foot, small-arterial disease (SAD) foot. It’s all the same amig@s! Time to stick to one nomenclature, definition and potential venues of ideal care. Stay tuned, multidisciplinary consensus in the making. @hendolat @dgarmstrong @diabeticfoot1 @BCM_Surgery
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What an honor! I’ve been a bit away from the platform throughout this transition process. I can’t wait to get started and working with the entire organization at @MethodistHosp to improve patient care through good & respectful team work. Let’s do this! #puravida.
How about this for a team that can transform limb salvage @monteromiguel ,new chief of Vascular Surgery at Houston Methodist and the amazing research from @trisharoymd. Can't wait! @VEITHsymposium @BLearningvideos @VascularSVS @ISEVSonline.
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68 yo M, hx MI, Afib, morbid obesity. 24 hrs ago underwent #watchman placement. Comes to ED with abdominal pain and leg weakness. On exam, monophasic waveforms from the CFA down bilaterally. Thoughts? Options for removal? @VascularSVS @BCM_Surgery @DeBakeyCVedu
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Long-awaited project. Excited to see where it leads! Now, very selected patients can get appropriate and responsible standard of care right at our office. @BCM_Surgery #comprehensivevascularcare #PADcare #AVFcare.
A new outpatient care clinic the Office Based Endovascular Lab, provides patients the option to have procedures performed in an office-based setting, quickly became very busy with patients seeking high-quality, high-service attention.
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Venous arterialization and highly specialized foot surgery are likely the best options on patients with desert foot.
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Kudos to all the PROMISE II investigators and the @CLI_LimFlow team. Very encouraging data shared by Dan Clair at @VIVAPhysicians #viva2022 - guess we’ll have to stop calling this patient population the “no option” group.
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Well-deserved! Here’s to my mentor, but more importantly a good friend! Salud Jose Molinos!.
Dr. Joseph Mills @jmills1955 First American to be named Associate Editor of European Journal of Vascular and Endovascular Surgery. He has been named Assoc. Editor of the PAOD Section. @EJVES_ESVS @hendolat @DrRosengart @ZSP_MD @monteromiguel @NealBarshes
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In complex PAD cases with extensive tissue loss, there’s a thin line between limb salvage and fueling a patient with unrealistic hope. How do you go about maneuvering this complex scenario in your practice? Thanks for sharing in advance! @BCM_Surgery @hendolat @Vascupedia_com.
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SUPER excited to share our first ever @hendolat regional conference in our own city of #Houston. SUPERB international faculty will accompany us for a 2-day event of a purely VENOUS conference. Please check the link! DM for any additional info! #MedTwitter
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What does it take to have 1500+ registered attendees, live cases from all over the world, top speakers and flawless production? A small, efficient and highly talented Latin American team! Thank you guys for your work. You’re the ❤️ of @hendolat Join us
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Never stop learning and sharing your knowledge! Today, with my good friends in Bergamo! What a #soulteam! Prof. Ferraresi just amazed us with a complex BTK case! Later today, we will be discussing the preliminary data on hybrid superficial venous arterialization @BCM_Surgery
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Looking forward to starting operations very soon. Thankful with everyone that’s collaborated to push this dream forward.
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Outside hospital referral. Admitted for CLTI stage 4 (forefoot gangrene). ESRD & DM2. We’ve accepted the transfer for care with our multidisciplinary team at #HOPEvascularpodiatry (@thetoedoctor @JillSommerset ). What are your thoughts on this patient’s options? @VascularSVS
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If you prep ahead of a AAA, why wouldn’t you prep the same way for a peripheral case? know what you’re dealing with and what tool(s) you’ll be using. #TexasVSsociety.
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Lift off!!! Very excited to chair this years event in Mexico City. @hendolat 2022 is full of new and exciting content! Follow us virtually if you can’t make the trip. @JennaWMontero #PAT2tequila #toeandflow #complexaortic #diabeticfoot #CLTI
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Honored to be part of the faculty at the Society for Vascular & Endovascular Surgeons of Singapore. Lots of great learning today at their amazing center for advanced clinical & surgical skills. @vascularpodcast @hendolat
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Attention Earth! This will interest you! 💕.
Introducing the American Limb Preservation Society (ALPS). We're working to eliminate preventable amputation over the next generation. Join the family.
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Great forum for open discussion on current PAD interventions. #FYA Kudos to @vascularIR for putting together a stellar event. @hendolat @Vascupedia_com
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Finally all together - Beyond excited of what this unique group of individuals will do for the #PAD world. #HOPE #HOPEhtx #HOPEglobal
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These two sexy machines made it to our new limb-preservation center #HOPE. Looking forward to some disruptive moments! #openingsoon @JillSommerset @thetoedoctor
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And this now you cross CTOs. Torque left. torque torque right. now torque torque left. #NatureTeachings #BCMstep #somosHENDOLAT @hendolat
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Division of Vascular and a Endovascular Surgery keeping up with hospital’s mandated safety trainings! 😃 #STEP #BCMVascular @BCM_Surgery @jmills1955
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Our @hendolat live case of the month tdy was full of great discussion. Treated a CLTI pt with occluded SFA using @AvingerInc and @veryanmed1 technology with a good technical result. Im a newbie to OCT guided atherectomy. Please share your thoughts on the technology. Pura vida!
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