ORCID Profile
0000-0002-7414-642X
Current Organisation
IRCCS Policlinico San Donato
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Publisher: Elsevier BV
Date: 10-2017
Publisher: Wiley
Date: 23-06-2019
DOI: 10.1002/CCD.28380
Abstract: We report a case of a celiac trunk stenting using a steerable guiding catheter, to fix a residual endoleak following fenestrated endovascular repair (FEVAR) of a thoraco-abdominal aortic aneurysm (TAAA). A systematic search of the literature about the use of steerable catheters was also performed on Pubmed according to the PRISMA Guidelines, including all papers in which the device was used for in vivo endovascular procedures. In our case report, the patient had undergone a failed attempt of cannulation due to the presence of a severely angulated and stenosed ostium of the vessel. A steerable catheter was then used to fix the residual endoleak. The search of the Literature retrieved 544 papers. Of them, 13 met the inclusion criteria and were therefore assessed. The use of steerable sheaths and catheters was reported as effective and safe for the cannulation of 157 target vessels in 131 endovascular procedures, with a success rate of 95.5% and no complications. The use of a steerable guiding catheter in our experience was safe and effective for the selective cannulation of a severely stenosed and angulated celiac trunk, to correct a residual endoleak after FEVAR for TAAA. Steerable catheters could be useful tools for the selective cannulation of target vessels with a challenging ostium.
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.AVSG.2018.03.040
Abstract: To assess the role of duplex ultrasound (DUS) in detecting endoleaks (ELs) and graft thrombosis (GT) in a cohort of patients submitted to endovascular aortic repair (EVAR) for elective infrarenal abdominal aortic aneurysm (AAA) in 2 centers. Data, of all consecutive patients treated in 2 operative units of vascular surgery, from January 01, 2000 to December 31, 2016, were retrospectively collected and evaluated. Follow-up data were analyzed to evaluate survival and device-related complications, both at 30-day and in the midterm. The results of computed tomography angiography (CTA) and DUS which were performed yearly, with a time interval between the 2 examinations lower than 30 days, were paired in terms of maximum transverse diameters of the aneurysmal sac, identification of EL, and of GT. Sensibility (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and accuracy (ACC) of the DUS were calculated with respect to data of each paired CTA and to data of the real clinical diagnosis of either EL or GT. A Student's t-test was performed to compare the aneurysmal sac diameters measured with DUS to those of CTA. "Kappa" coefficient of agreement was also calculated. A P value < 0.05 was the level reference for statistical significance. A total of 920 patients (104 female, 11.3%) underwent EVAR for elective infrarenal AAA. Technical success was achieved in 910 cases (98.9%). At 30 days, there were 5 deaths (0.5%), no GT, and 3 small type II ELs which did not require any adjunctive procedure. Mean follow-up was 64.8 months (range 1-120.3 months). Survival and freedom from complications were estimated to be 78.4% ± 1.9% and 48.3% ± 1.7%, respectively, at 10 years. Seventy-six more ELs and 8 GTs were recorded. Considering the CTA as the gold standard, SE, SP, and ACC of DUS in the detection of the EL were 93.2% ± 5.8%, 98.8% ± 1.1%, and 97.8%, respectively, with a PPV of 94.5% ± 5.2% and a NPV of 98.3% ± 1.4%. Considering, however, the real diagnosis of the EL, SE, SP, and ACC of DUS were slightly lower (89.4% ± 6.9%, 98.5% ± 1.3%, and 96.9%, respectively), as well as PPV and NPV (93.1% ± 5.8% and 97.7% ± 1.6%, respectively). K coefficient of agreement between the measurements of the sac maximum transverse diameter recorded at DUS and CTA was 0.91, with a little underestimation of the aneurysm diameter at DUS if compared with CTA (mean diameter difference of 2.5 mm, 95% confidence interval: 2.25-2.75 mm). DUS has proven to be a reliable examination in identifying all GT and most ELs after EVAR, compared with CTA. A good correlation was also observed between the measurements of the sac maximum transverse diameter recorded at DUS and CTA, with a little underestimation of the aneurysm diameter at DUS compared with CTA.
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/J.EJVS.2014.10.005
Abstract: To analyze the variability of origin of the celiac trunk (CT), the superior mesenteric artery (SMA), the right renal artery (RRA), and the left renal artery (LRA) in terms of mutual distances, angle from the sagittal aortic axis (clock position), and ostial diameters on computed tomography angiographies (CTAs) in three groups of patients. One hundred and fifty CTAs of 50 patients with a non-dilated thoracoabdominal aorta (group A), 50 with thoracoabdominal aneurysm (B), and 50 with infrarenal aneurysm (C) were reviewed. The measurements performed on CTAs, as well as the patients' age, sex, and body surface area, were analyzed. p values <.05 were considered statistically significant. The clock position of the CT and the SMA, the diameters of all vessels, and the distance of the CTeSMA followed a Gaussian distribution. In contrast, the clock position of the renal vessels did not follow a normal distribution, and nor did the distances of the SMA-RRA, SMA-LRA, RRA-LRA or the distances between the renal arteries and the aortic bifurcation. The same values did not differ significantly among the three groups, with the exception of the distances between the renal arteries and the aortic bifurcation, significantly greater in group C. The clock position of the LRA and the distances of the SMA-LRA, SMA-RRA, RRA-LRA and between both renal arteries and the aortic bifurcation showed a significant correlation with the increase of aortic diameter. The anatomic variability of the origin of both the CT and the SMA in terms of clock position and mutual distances followed a Gaussian distribution, regardless of group. The same applies to the ostial diameters of renal and visceral vessels. In contrast, the origin of the renal vessels had a statistically significant heterogeneity that seemed to be correlated with the increase of aortic diameter in the mesenteric and renal aortic region.
Publisher: Galenos Yayinevi
Date: 02-11-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2019
DOI: 10.2459/JCM.0000000000000799
Abstract: To report our experience about hypogastric artery coverage during endovascular aneurysm repair (EVAR) for aortoiliac aneurysms in patients younger than 80 years (group A) compared with octogenarian patients (group B). Data of consecutive EVAR with hypogastric artery coverage from 01/1998 to 12/2016 were retrospectively analyzed. Primary outcomes were the occurrence of ischemic colitis, type II endoleak and buttock claudication both at 30 days and in the long term. P values less than 0.05 were considered statistically significant. The hypogastric artery was covered in 107 patients. Twenty-three (21.5%) were octogenarian (group B). At 30 days, one type II endoleak occurred in group B, whereas 16 patients of group A experienced buttock claudication. There were no cases of ischemic colitis. During follow-up (median 63.5 months), no cases of ischemic colitis occurred. Six new type II endoleaks were recorded (five in group B and one in group A, P = 0.0001). Buttock claudication persisted in four patients of group A. No new cases of buttock claudication were observed. Unilateral hypogastric artery coverage during EVAR for aortoiliac aneurysms can be performed with an acceptable rate of postoperative complication. Postoperative buttock claudication was more frequent in younger patients, whereas a type II endoleak occurred mostly in octogenarian patients during follow-up.
Publisher: Elsevier BV
Date: 09-2020
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.AVSG.2015.04.062
Abstract: The risk of intraoperative open conversion during endovascular aortic repair (EVAR) still remains a main issue, albeit in a small percentage of cases. Open conversion can be extremely demanding and risky in relation to the type of the stent graft implanted and can be somehow challenging even for the most experienced vascular surgeons. We discuss a case of immediate conversion and 1 case of late conversion in patients previously treated with EVAR using the Ovation stent graft. The design of the endograft and its proximal sealing allowed the partial preservation of the graft and its use for proximal and distal anastomosis with a Dacron graft in both presented cases.
Publisher: SAGE Publications
Date: 06-2012
Abstract: We report our experience about carotid artery stenting (CAS) in patients 80 years and older. Out of 582 patients who underwent CAS at our institution from January 1999 to June 2010, 102 patients (group A) were 80 years or older. The clinical data of these patients were retrospectively reviewed, outcomes analyzed, and compared with those of younger patients who underwent CAS during the same period (group B). Outcomes of group B were similar to those of group A, both at 30 days and at long term. Male gender, symptoms, and not using an embolic protection device were related to long-term complications in both groups. Occurrence of bradycardia/asystole during CAS was a risk factor for long-term myocardial infarction for group A only. CAS can be safely performed in patients 80 years or older, with results that compare favorably to those of younger patients.
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.AVSG.2015.06.096
Abstract: Recently, the new Cordis INCRAFT abdominal aortic aneurysm (AAA) Stent-Graft System ultra low-profile device has been introduced in the clinical practice of endovascular aortic repair (EVAR) for the treatment of infrarenal AAAs (iAAAs). In our operative unit, it has been used since November 2014. We report our initial experience with the use of this novel device. We further discuss some technical aspects about the use of the endograft. Data of all patients undergoing elective EVAR in our Division of Vascular Surgery using the Cordis INCRAFT AAA Stent-Graft System from November 2014 till now were retrospectively collected in a database and outcomes reviewed. Follow-up data were analyzed to evaluate primary success, survival, complications, and device-related events. Statistical analysis was performed using JMP(®) 5.1.2 (SAS Institute Inc., Cary, NC). Continuous variables are reported as mean ± standard deviation, and categorical variables are presented as n (%). From November 2014 till now in our institution, a total of 10 patients (7 male mean age, 76.3 years old range, 65-87 years) underwent elective exclusion of an iAAA with a challenge iliac anatomy (minimum access vessel, 6.7 mm) using Cordis INCRAFT endoprosthesis. There were 9 AAA and a left common iliac artery aneurysm 50 mm in diameter, involving the internal iliac artery. Primary success was achieved in 90% as 1 patient presented an immediate type Ia endoleak which was resolved by the placement of a proximal aortic cuff. There was 1 intraoperative acute leg ischemia requiring a left popliteal Fogarty thrombectomy. Three patients (30%) presented a postimplantation syndrome. No other complications occurred neither during in-hospital stay (mean, 3.4 days range, 2-4 days) nor during follow-up. In our experience, the Cordis INCRAFT AAA System was a safe and effective device. Our reflections about technical aspects of the use of this device will probably find their answer when further studies will report shared experiences and results about using this type of endograft.
Publisher: Oxford University Press (OUP)
Date: 28-04-2016
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.MEHY.2016.06.016
Abstract: One of the technical problems which can be encountered during the endovascular repair (EVAR) of abdominal aortic aneurysms, is represented by the challenge of cannulation of the contralateral gate after the opening of the main body of the endograft, especially in case of tortuous aorta-iliac anatomy. Aim of this work is to propose a hypothesis of simplification, verifying the possibility to maximize the area available for the cannulation of the contralateral gate by simulating an oblique distal end of the leg of the most used devices, without affecting the correct sealing between the main body and the iliac extension. Data about the contralateral gate of the main body of endografts most used for EVAR were analyzed. The elliptical sectional area resulting from the simulation of the oblique cut was calculating with some geometric formulas. Then the gain of "disposable area" for the cannulation of the contralateral gate was calculated as a percentage of the elliptical area resulting in maximum distal oblique cut, with respect to the nominal circular area of the base. The only endografts which could undergo an oblique cut without losing the sealing between the main body and the contralateral limb were the Incraft, the Treovance and the Ovation, for which it would be possible to obtain a surface gain up to 84%, 22.8% and 14.4% respectively (being 9.8% in case of Ovation with the main body 29 and 34). A simulation of oblique cut was also performed on the endografts which currently do not allow to do so without a loss of sealing, assuming to lengthen the contralateral gate of an arbitrary measure of 10mm. In these cases, the percentage of surface gain was greater for endoprostheses which had a smaller diameter of the contralateral leg. The oblique cut of the contralateral gate allowed a gain of the surface available for the cannulation, however it was not applicable to all models of currently available endoprostheses, unless of a loss of sealing between the main body and the contralateral iliac limb.
Publisher: Elsevier BV
Date: 03-2018
Publisher: Springer Science and Business Media LLC
Date: 06-04-2017
DOI: 10.1007/S00595-017-1525-7
Abstract: To present a real-world experience of the elective treatment of abdominal aortic aneurysms (AAAs) using both open repair (OR) and endovascular repair (EVAR). Data from patients treated consecutively between January 1, 2000 and December 31, 2014 were collected retrospectively and reviewed. The primary outcomes were 30-day mortality and complication rates, freedom from reintervention, and survival in the long-term. We analyzed data on 1112 patients (660 EVAR, 452 OR). The 30-day mortality and complications rates were higher after OR than after EVAR (2.9 vs. 1.1%, P = .03 and 24.7 vs. 1.1%, P < .0001, respectively). At 10 years, survival was 66.1 ± 3.2% after OR and 78.1 ± 2.2% after EVAR (P = .0006) and freedom from reintervention was 93.5 ± 1.8% after OR and 88.4 ± 1.8% after EVAR (P = .005). The preoperative aneurysm diameter was significantly associated with the development of type Ia endoleaks after EVAR (P < .0001) and of a proximal pseudoaneurysm after OR (P < .0001). In the long-term, EVAR was associated with higher reintervention rates, but better survival than OR. The preoperative AAA diameter was the most important predictor of the development of endoleaks after EVAR and proximal pseudoaneurysm after OR.
Publisher: Springer Science and Business Media LLC
Date: 02-01-2019
DOI: 10.1007/S00270-018-2149-Z
Abstract: The aim of this study was to review the literature about the occurrence of postoperative type I endoleak (EL) and chimney graft thrombosis (CGT) after the use of sealing devices in chimney endovascular aortic repair (Ch EVAS), compared to chimney EVAR using conventional devices (Ch EVAR). A systematic review of the literature on PubMed and MEDLINE with the terms "Chimney" and "Parallel grafts" was performed. The review was set up following the PRISMA guidelines. Case series about the use of the chimney/snorkel technique during endovascular repair of juxtarenal ararenal aneurysms (AAA) were considered. Only papers with full text available in English and reporting complete data with at least 1 month of follow-up about at least 5 cases were included in the analysis. In total, 90 papers were assessed for eligibility. According to the inclusion criteria, only 25 papers could be analyzed (20 in the Ch EVAR group and 5 in the Ch EVAS group). A type I EL occurred in 9.3% after Ch EVAR (95% CI 7.1-12.2%) and in 8.3% after Ch EVAS (95% CI 3.5-18.5%), being not significantly different. CGT occurred in 10.7% of cases after Ch EVAR (95% CI 8.8-13%) and in 8.8% of cases after Ch EVAS (95% CI 3.3-21.3%), being also not significantly different. The reported rate of type I EL and CGT occurring after Ch EVAR tended to be slightly higher than those reported after Ch EVAS, even if the difference was not statistically significant.
Publisher: Elsevier BV
Date: 2016
Publisher: SAGE Publications
Date: 31-07-2019
Abstract: Purpose: To investigate the association between the bird-beak configuration (BBC), a wedge-shaped gap between the undersurface of a thoracic endograft and the lesser curvature of the arch after thoracic endovascular aortic repair (TEVAR), and postoperative outcome after TEVAR. Methods: The study was performed according to the PRISMA guidelines. The PubMed, EMBASE, and Cochrane databases were searched to identify all case series reporting BBC after TEVAR between 2006 and April 2018. Data analysis was performed considering the difference in the risk of complications for presence vs absence of BBC. After screening 1633 articles, 21 studies were identified that matched the selection criteria 12 of these reported detailed information to investigate the postoperative outcome using proportion meta-analysis with a random effects model. The pooled risk difference is reported with the 95% confidence interval (CI). Heterogeneity of the included studies was assessed with the I 2 statistic (low 25%, medium 50%, high 75%). Results: Complications occurred within a range of 0 to 72 months in 14.7% (95% CI 7.4% to 27.3%) of patients with BBC and in 6.3% (95% CI 2.5% to 15.4%) of patients without BBC. A cumulative incidence could not be assessed. The summary risk difference was 11.1% (95% CI −0.1% to 22.3%, p=0.052). There was significant heterogeneity ( I 2 =85.6%). The Egger test did not show evidence of publication bias (p=0.975). When specifically considering type Ia endoleak and endograft migration, the risk difference between BBC and non-BBC patients was 8.2% (95% CI 0.3% to 16.1%, p=0.042 I 2 =69.0%). The specific risk difference for endograft collapse/infolding and thrombosis was 3.7% (95% CI −3.5% to 11.1%, p=0.308 I 2 =10.2%). Conclusion: At present the literature does not provide statistical evidence to establish an overall prognostic value of the BBC. Nevertheless, the BBC appears to be associated with a high risk of type Ia endoleak and endograft migration, which warrants specific and long-term surveillance. Clinically relevant values for BBC grading should be established to perhaps define indications for preemptive treatment based on the presence of BBC only.
Publisher: Wiley
Date: 18-07-2020
DOI: 10.1002/CCD.29140
Publisher: Elsevier BV
Date: 08-2020
Publisher: SAGE Publications
Date: 2019
Abstract: Atherosclerosis and osteoporosis are interrelated entities and share similar pathogenic mechanisms. Recent studies showed that key proteins of bone metabolism, such as osteoprotegerin (OPG) and osteopontin (OPN), are also involved in vascular atherosclerosis and calcifications. The carotid intima-media thickness (CA-IMT) is an early quantitative marker of generalized atherosclerosis. Aim of study was to investigate whether 12-months treatment with zoledronate (ZLN) or teriparatide (TPT) affects CA-IMT and circulating OPG and OPN levels. In this study, 11 postmenopausal osteoporotic women (aged 73, 70.5–74.5 years median, range interquartile) treated with 5 mg/year iv ZLN 9 postmenopausal osteoporotic women (aged 70, 62.5–73.5 years) treated with 20 µg/day sc TPT and 10 aged-, body mass index (BMI)-, glycemic, and lipid profiles-matched, free from anti-osteoporotic and hypocholesterolemic drugs, controls were prospectively investigated at baseline and after 12 months. At baseline, median CA-IMT was similar in the three groups and increased after 12 months. CA-IMT increased significantly in TPT-treated patients (1.0, 0.8–1.2 vs 1.1, 0.9–15 mm, P = 0.04), though the change was minimal. After 12 months of treatment, CA-IMT positively correlated with alkaline phosphatase (ALP) levels (r = 0.767, P = 0.008) and negatively with high-density lipoprotein (HDL) cholesterol levels (r = −0.65, P = 0.03), suggesting interplay between active bone remodeling and lipid profile. At baseline and after 12 months, median serum OPG and OPN levels did not differ among the groups and did not correlate with changes in CA-IMT. In conclusion, ZLN and TPT treatments are safe on carotid walls in osteoporotic women with subclinical atherosclerosis circulating OPG and OPN are not affected by long-term anti-osteoporotic treatments and do not correlate with CA-IMT.
Publisher: Elsevier BV
Date: 12-2017
Publisher: Springer International Publishing
Date: 11-07-2019
Publisher: SAGE Publications
Date: 11-2020
Abstract: This retrospective study was performed to assess the clinical and radiological variables associated with proximal type IA endoleak (EL) in patients treated with elective endovascular repair for abdominal aortic aneurysms. The chi-square test, t-test, and logistic regression analysis were performed as appropriate. A P value of .05 was considered statistically significant. The data of 79 patients were analyzed. No mortality occurred. During follow-up (median, 28.5 months interquartile range, 12.8–43.0 months), 10 patients developed type IA EL. In the logistic regression analysis, undersizing of the endograft diameter by % significantly affected the occurrence of type IA EL. When the diameter was used for measurements, less oversizing was significantly associated with a higher risk of type IA EL. When the area was used for measurements, oversizing of % significantly affected the occurrence of type IA EL. When sizing endografts, a discrepancy was noted between the measurements of the diameter and area of the proximal neck. The area might represent a more accurate measurement than the axial diameter to optimize the proximal sealing and lower the risk of developing type IA EL.
Publisher: Future Medicine Ltd
Date: 09-2020
Abstract: Aim: To investigate the effect of a new platform of nanocarriers, called nanodroplets (NDs), to enhance the in vitro activity of vancomycin (Vm), against bacterial colonies isolated from chronic ulcers of the lower limbs. Materials & methods: Oxygen-loaded nanodroplets (OLNDs) or oxygen-free nanodroplets (OFNDs) were loaded with Vm (Vm-OLNDs and Vm-OFNDs). MIC and minimal bactericidal concentrations were evaluated for Vm, OLNDs and OFNDs loaded with Vm, OLNDs and OFNDs. Results & conclusion: Nanodroplets, either with or without oxygen, appeared as a suitable platform of antibiotic nanocarriers to enhance the antibacterial effects of Vm against Enterococci, with a decrease in both MIC and minimal bactericidal concentration against Vm-resistant Enterococci strains.
Publisher: Elsevier BV
Date: 08-2019
DOI: 10.1016/J.JVS.2018.10.121
Abstract: The objective of this study was to analyze preoperative risk factors affecting long-term survival and the occurrence of stroke in patients older than 80 years undergoing either carotid endarterectomy (CEA) or carotid artery stenting (CAS) for carotid stenosis. Data of all consecutive patients treated from January 1999 to December 2017 were retrospectively reviewed and outcomes analyzed. Kaplan-Meier analysis was used to estimate long-term survival and the risk of stroke for both groups. Cox proportional hazards analysis was used to assess the relative risk of all-cause mortality and long-term stroke for patients in the presence of selected comorbidities, including preoperative symptoms, coronary artery disease, chronic renal failure, atrial fibrillation (AF), hypertension, diabetes mellitus, and dyslipidemia. A P value <.05 was considered statistically significant. A total of 473 patients older than 80 years (298 men [63%]) underwent either CEA (n = 178) or CAS. At 30 days, one patient died in the CEA group of unrelated causes no deaths were recorded after CAS (0.6% vs 0% P = .18). At 5 years, survival was 67.6% ± 4.9% after CEA and 90.2% ± 2.3% after CAS (P < .0001). The main cause of death after CEA and CAS was a neoplasm. Estimated freedom from any stroke at 5 years was 97.3% ± 0.5% after CEA and 93.2% ± 1.2% after CAS (P = .07). The presence of preoperative AF significantly affected long-term mortality after CAS (hazard ratio [HR], 1.56 95% confidence interval [CI], 1.34-1.98 P = .04) as well as being classified as American Society of Anesthesiologists class 3 at evaluation of the preoperative anesthesiology risk. The presence of preoperative AF was the only factor that significantly affected the occurrence of long-term stroke after both CAS (HR, 2.28 95% CI, 1.86-5.63 P = .001) and CEA (HR, 3.45 95% CI, 2.29-8.19 P = .005). Both CEA and CAS showed low 30-day mortality and any-stroke rates in patients older than 80 years. In the long term, survival was significantly better after CAS however, deaths after CEA and CAS were mainly unrelated to the procedure. No significant differences were recorded in the occurrence of any stroke in the long term. The presence of preoperative AF significantly affected long-term survival after CAS as well as being classified as American Society of Anesthesiologists class 3 at evaluation of the preoperative anesthesiology risk. The presence of preoperative AF also significantly affected long-term risk of stroke after both CAS and CEA.
Publisher: Elsevier BV
Date: 08-2014
DOI: 10.1016/J.AVSG.2014.03.001
Abstract: We report our retrospective experience on postimplantation syndrome (PIS) after the use of Anaconda™ endograft in patients undergoing elective endovascular repair of abdominal aortic aneurysms (EVAR). Data of all patients undergoing elective EVAR between May 2000 and June 2013 using the Anaconda endograft were retrospectively reviewed and the outcomes were analyzed. Preoperative and intraoperative data, any early postoperative complications, length of in-hospital stay, incidence of PIS, and long-term complications were recorded in a database. Patients' quality of life (QOL) was also assessed at 1 month after the procedure. Statistical analysis was performed and P values ≤0.05 were considered statistically significant. Chi-squared tests, log-rank tests, Wilcoxon tests, and Kaplan-Meier survival analysis were performed as appropriate. Between May 2000 and June 2013, 118 patients (8 female, 6.7%) underwent elective EVAR using the Anaconda endograft. Primary success was obtained in 117 cases (99.1%). Patients were ided into 2 groups based on either the occurrence of PIS (group A: 24 patients, 20.3%) or not (group B). The length of the procedure and the in-hospital stay were longer for group A. One patient from group B died on second postoperative day from myocardial infarction (0.8%). Mean follow-up was 48.4 months (range 5-162 months). Seven endoleaks occurred in the long term regardless of the development of PIS. We did not find any correlation between the presence of PIS and the occurrence of long-term complications, but PIS was correlated to the preoperative burden of thrombus of the aneurysmal sac. On the other side, analysis of QOL surveys showed that patients who had PIS after surgery felt significantly more limited in carrying out their daily physical activities and were more emotionally discouraged and depressed/anxious about their state of health than the group that did not have PIS. In our experience, the occurrence of PIS was related to the duration of the procedure and the preoperative burden of thrombus of the aneurysmal sac. Overall, PIS was a benign complication after EVAR using the Anaconda endograft. However, it affected significantly the length of the in-hospital stay. Moreover, patients who had PIS after surgery felt significantly more limited in carrying out their daily physical activities and were more emotionally discouraged and depressed/anxious about their state of health than the group that did not have PIS.
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.AVSG.2017.05.012
Abstract: We report a preliminary experience about endovascular aortic repair (EVAR) of infrarenal abdominal aortic aneurysm (iAAA) with severe proximal aortic neck angulation (NA) using the Aorfix™ stent graft. Data of consecutive patients with iAAA with severe proximal NA submitted to endovascular repair between September 2012 and December 2014 in 2 Italian centers of Vascular and Endovascular Surgery were retrospectively reviewed, and outcomes were analyzed using the software JMP 5.1.2. A total of 26 patients were treated. Median proximal NA was 87.5° (range 68-108°), and 3 patients were treated outside the instruction for use of Aorfix because of a proximal NA > 90°. Eleven patients (42.3%) had severe iliac tortuosity. The primary success rate was 92.3%, as 2 patients required intraoperative correction of a type Ia endoleak. Within 30 days, a right limb occlusion was successfully resolved with endovascular recanalization. The median follow-up period was 14 months (range 1-48 months): 1 patient died for neoplasm and 1 patient presented a type II endoleak from lumbar arteries at 3 months, which is still under surveillance. No other complications were reported during the follow-up period. Preliminary results with the Aorfix stent graft seemed to be promising in the aim of reducing endoleak and migration rates in presence of iAAA with severe proximal aortic NA.
Publisher: Springer Science and Business Media LLC
Date: 29-04-2013
Publisher: Springer Science and Business Media LLC
Date: 27-05-2011
Publisher: Springer Science and Business Media LLC
Date: 12-03-2014
Publisher: Springer Science and Business Media LLC
Date: 10-07-2012
Publisher: Springer Science and Business Media LLC
Date: 24-05-2011
Abstract: We report a case of delayed endovascular correction of graft collapse occurred after emergent Thoracic Endovascular Aortic Repair (TEVAR) for traumatic aortic isthmus rupture. In 7 th post-operative day after emergent TEVAR for traumatic aortic isthmus rupture (Gore TAG ® 28-150), a partial collapse of the endoprosthesis at the descending tract occurred, with no signs of visceral ischemia. Considering patient's clinical conditions, the graft collapse wasn't treated at that time. When general conditions allowed reintervention, the patient refused any new treatment, so he was discharged. Four months later the patient complainted for severe gluteal and sural claudication, erectile disfunction and abdominal angina endovascular correction was performed. At 18 months the graft was still patent. Graft collapse after TEVAR is a rare event, which should be detected and treated as soon as possible. Delayed correction of this complication can be lethal due to the risk of visceral ischemia and limbs loss.
Publisher: Hindawi Limited
Date: 2011
DOI: 10.1155/2011/604362
Abstract: We report two cases of descending thoracic aorta floating thrombus treated with Bolton Relay thoracic free-flow stent graft. The patients had symptoms of lower limb ischemia they underwent preoperative angiography and CTscan, then we proceeded with endovascular exclusion of the thrombus from the systemic circulation. At 12 months, the graft was still patent in both patients, without any signs of endoleak.
Publisher: Elsevier BV
Date: 07-2020
DOI: 10.1016/J.AVSG.2019.11.041
Abstract: The aim of the study was to report early and late outcomes of surgical and endovascular management of subclavian artery atherosclerotic disease (SAAD). Data about consecutive patients treated for subclavian artery atherosclerotic occlusive disease between 2001 and 2018 either by open surgical repair (OSR) or by endovascular repair (ER) were retrospectively collected and analyzed. Primary outcomes included 30-day death, as well as cardiac and neurologic events, reported separately for occlusion and stenosis. Secondary outcomes included primary patency in the long term, reported separately for occlusive and stenotic lesions. The Kaplan-Meier analysis with the logrank test was used to estimate long-term primary patency. Chi-squared and t-tests were used as appropriate to compare the outcomes of the 2 groups. A P value < 0.05 was considered statistically significant. Sixty-eight patients were treated using ER (49 patients) and OSR (19). Technical success rate was 100% in both groups. During in-hospital stay, 1 brachial hematoma and 2 acute upper limb ischemia occurred in the ER group and in the OSR group, respectively. At 30 days, no deaths or neurological/cardiac events were recorded in both ER and OSR groups. Symptoms resolution and upper limb salvage were 100% in both groups. In the ER group, primary patency was 100% at 7 years in patients who had been treated for stenotic lesions and 62.5 ± 21.3% in patients who had been treated for occlusive lesions (P = 0.0035). In the OSR group, primary patency was 100% at 7 years in patients treated for stenotic lesions and 25 ± 21.6% in patients who had been treated for occlusive lesions (P < 0.0001). Overall, long-term primary patency in the OSR group was 76.9 ± 11.7% at 7 years, being lower than that reported after ER (93.4 ± 4.5%, P = 0.02). Both ER and OSR proved to be safe, effective, and durable in the treatment of SAAD. In particular, the primary patency rates at long term for both ER and OSR showed better outcomes for stenotic lesions.
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.JVS.2017.04.076
Abstract: The objective of this study was to describe in the general population the anatomy of the supra-aortic trunks (SATs: brachiocephalic trunk [BCT], left common carotid artery [LCCA], and left subclavian artery [LSA]) arising from the aortic arch in terms of mutual distances from the valvular aortic plane (VAP), ostial diameters, and clock face orientation from the sagittal aortic axis, with an analysis of each distribution. Measurements of 252 computed tomography angiograms of the aortic arch and SATs in three groups of patients (84 without any disease of the aortic arch, group A 84 with dilation of the aortic arch, group B 84 with dilation of the descending thoracic aorta below the LSA, group C) were retrospectively collected and analyzed. The Shapiro-Wilk test was used to assess normality of each distribution. The ostial diameters of the SATs followed a gaussian distribution in all groups. In group A, only VAP-BCT and LCCA-LSA distances were normal, being in 95% of cases between 46.6 and 88.2 mm and between 8 and 23.3 mm, respectively. In both groups B and C, the distance VAP-BCT and the takeoff angle of both LCCA and LSA were gaussian distributed (being in 95% of cases between 48.5 and 102.1 mm, -17.6° and 33°, and -17.7° and 23.4°, respectively, in group B and between 51.3 and 101.1 mm, -28.2° and 33.7°, and -28.7° and 31.3°, respectively, in group C). VAP-BCT distance and BCT angle were lower in group A compared with group B (P < .001 and P = .008, respectively) and group C (P < .001 and P = .04, respectively). Irrespective of the group, all SAT mutual distances and ostial diameters were related to the aortic diameters, being greater for increasing aortic diameters. Neither BCT angle nor LSA angle was related to the aortic diameters, whereas LCCA angle was inversely correlated. Most of the analyzed variables did not show a gaussian distribution, both in healthy and in diseased patients. Irrespective of the group, all SAT mutual distances and ostial diameters were related to the aortic diameters, being greater for increasing aortic diameters.
Publisher: Elsevier BV
Date: 05-2020
DOI: 10.1016/J.AVSG.2019.11.042
Abstract: Iatrogenic femoral arteriovenous fistulas (AVFs) and deep venous thrombosis (DVT) can complicate femoral artery catheterization procedures. However, the co-occurrence of both is rare. We report the unique case of AVF with DVT, which occurred in the right femoral vessels of a 59-year-old man with a right iliac fossa kidney transplant, after percutaneous puncture for cardiac catheterization. Duplex ultrasound examination and computed tomography venography scan confirmed the diagnosis. Both the AVF and the DVT were managed surgically.
No related grants have been discovered for Daniela Mazzaccaro.