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Speziale F, Mansour W, Ancetti S, Antonello M, Bissacco D, Boschetti GA, Camparini S, Cariati M, Colacchio EC, Dajci A, Deiana G, Femia M, Gallitto E, Gargiulo M, Genadiev G, Grassi V, Grego F, Ianni G, Iocca ML, Lenti M, Loschi D, Melissano G, Novali C, Orso M, Palombo D, Piffaretti G, Pratesi G, Rinaldi E, Ronchey S, Spertino A, Trimarchi S, Lanza G. Guidelines on prevention, diagnosis and treatment of thoracic and thoracoabdominal aortic pathology: updates from the Italian Society of Vascular and Endovascular Surgery (SICVE). THE JOURNAL OF CARDIOVASCULAR SURGERY 2025; 66:142-164. [PMID: 40372107 DOI: 10.23736/s0021-9509.25.13270-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2025]
Abstract
The aim of these Guidelines was to refresh and enhance the earlier 2015 Italian Guidelines regarding Thoracic and Thoracic - Abdominal Aortic Disease, aligning them with the National Guidelines System (SNLG) to assist all healthcare professionals in adopting the most appropriate treatment approach for this condition. The update utilized the GRADE-SIGN version methodology, adhering to the AGREE checklist for quality reporting. The initial step involved crafting clinical questions in the PICO (Population, Intervention, Comparison, Outcome) format to base the Recommendations on. Following this, systematic literature reviews were conducted for each PICO question or for related clusters of questions, leading to article selection and evaluation of their methodological quality via qualitative checklists. Subsequently, a Considered Judgment form was completed for each clinical question, assessing the overall evidence to facilitate the conversion from evidence level to recommendation strength and direction. These guidelines outline the best practices for managing thoracic-abdominal aortic disease, with a focus on screening and monitoring. They explore medical treatments and criteria for surgical intervention, including a thorough preoperative analysis of the patient's history and an assessment of surgical risks. Following the determination of surgical necessity, the guidelines compare traditional open surgery with endovascular procedures, paying particular attention to define new recommendations where there were not. Systematic literature reviews were executed for each PICO question. Considered judgments were made through evaluating the evidence level, and the recommendations, direction and strength. The document concludes by outlining protocols for both immediate and prolonged postoperative care. Recent literature has not only validated and refined previous recommendations but also introduced new ones on emerging topics.
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Affiliation(s)
- Francesco Speziale
- Department of Vascular Surgery, Umberto I Polyclinic Hospital, Rome, Italy
| | - Wassim Mansour
- Department of Vascular Surgery, Umberto I Polyclinic Hospital, Rome, Italy -
| | - Stefano Ancetti
- Department of Vascular Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Michele Antonello
- Department of Vascular Surgery, Padua University Hospital, University of Padua, Padua, Italy
| | - Daniele Bissacco
- Department of Vascular Surgery, Fondazione IRCCS Ca' Granda Maggiore Polyclinic Hospital, Milan, Italy
| | - Gian A Boschetti
- Department of Vascular Surgery, San Martino University Hospital, Genoa, Italy
| | - Stefano Camparini
- Department of Vascular Surgery, Bortzu University Hospital, Cagliari, Italy
| | | | - Elda C Colacchio
- Department of Vascular Surgery, Padua University Hospital, University of Padua, Padua, Italy
| | - Ada Dajci
- Department of Vascular Surgery, Umberto I Polyclinic Hospital, Rome, Italy
| | - Giuseppe Deiana
- Department of Vascular Surgery, Bortzu University Hospital, Cagliari, Italy
| | - Marco Femia
- Department of Radiology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Enrico Gallitto
- Department of Vascular Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Mauro Gargiulo
- Department of Vascular Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Genadi Genadiev
- Department of Vascular Surgery, Bortzu University Hospital, Cagliari, Italy
| | - Viviana Grassi
- Department of Vascular Surgery, Fondazione IRCCS Ca' Granda Maggiore Polyclinic Hospital, Milan, Italy
| | - Franco Grego
- Department of Vascular Surgery, Padua University Hospital, University of Padua, Padua, Italy
| | - Giulia Ianni
- Department of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy
| | - Maria L Iocca
- Department of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy
| | - Massimo Lenti
- Department of Vascular Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Diletta Loschi
- Department of Vascular Surgery, San Raffaele University Hospital, Milan, Italy
| | - Germano Melissano
- Department of Vascular Surgery, San Raffaele University Hospital, Milan, Italy
| | - Claudio Novali
- Association of Vascular Patients "TiToccoToccati", Turin, Italy
| | - Massimiliano Orso
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, Perugia, Italy
| | - Domenico Palombo
- Department of Vascular Surgery, San Martino University Hospital, Genoa, Italy
| | | | - Giovanni Pratesi
- Department of Vascular Surgery, San Martino University Hospital, Genoa, Italy
| | - Enrico Rinaldi
- Department of Vascular Surgery, San Raffaele University Hospital, Milan, Italy
| | - Sonia Ronchey
- Department of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy
| | - Andrea Spertino
- Department of Vascular Surgery, Padua University Hospital, University of Padua, Padua, Italy
| | - Santi Trimarchi
- Department of Vascular Surgery, Fondazione IRCCS Ca' Granda Maggiore Polyclinic Hospital, Milan, Italy
| | - Gaetano Lanza
- Department of Vascular Surgery, IRCCs MultiMedica, Castellanza Hospital, Castellanza, Varese, Italy
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Geronzi L, Martinez A, Rochette M, Yan K, Bel-Brunon A, Haigron P, Escrig P, Tomasi J, Daniel M, Lalande A, Lin S, Marin-Castrillon DM, Bouchot O, Porterie J, Valentini PP, Biancolini ME. Computer-aided shape features extraction and regression models for predicting the ascending aortic aneurysm growth rate. Comput Biol Med 2023; 162:107052. [PMID: 37263151 DOI: 10.1016/j.compbiomed.2023.107052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/27/2023] [Accepted: 05/20/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE ascending aortic aneurysm growth prediction is still challenging in clinics. In this study, we evaluate and compare the ability of local and global shape features to predict the ascending aortic aneurysm growth. MATERIAL AND METHODS 70 patients with aneurysm, for which two 3D acquisitions were available, are included. Following segmentation, three local shape features are computed: (1) the ratio between maximum diameter and length of the ascending aorta centerline, (2) the ratio between the length of external and internal lines on the ascending aorta and (3) the tortuosity of the ascending tract. By exploiting longitudinal data, the aneurysm growth rate is derived. Using radial basis function mesh morphing, iso-topological surface meshes are created. Statistical shape analysis is performed through unsupervised principal component analysis (PCA) and supervised partial least squares (PLS). Two types of global shape features are identified: three PCA-derived and three PLS-based shape modes. Three regression models are set for growth prediction: two based on gaussian support vector machine using local and PCA-derived global shape features; the third is a PLS linear regression model based on the related global shape features. The prediction results are assessed and the aortic shapes most prone to growth are identified. RESULTS the prediction root mean square error from leave-one-out cross-validation is: 0.112 mm/month, 0.083 mm/month and 0.066 mm/month for local, PCA-based and PLS-derived shape features, respectively. Aneurysms close to the root with a large initial diameter report faster growth. CONCLUSION global shape features might provide an important contribution for predicting the aneurysm growth.
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Affiliation(s)
- Leonardo Geronzi
- University of Rome Tor Vergata, Department of Enterprise Engineering "Mario Lucertini", Rome, Italy; Ansys France, Villeurbanne, France.
| | - Antonio Martinez
- University of Rome Tor Vergata, Department of Enterprise Engineering "Mario Lucertini", Rome, Italy; Ansys France, Villeurbanne, France
| | | | - Kexin Yan
- Ansys France, Villeurbanne, France; University of Lyon, INSA Lyon, CNRS, LaMCoS, UMR5259, 69621 Villeurbanne, France
| | - Aline Bel-Brunon
- University of Lyon, INSA Lyon, CNRS, LaMCoS, UMR5259, 69621 Villeurbanne, France
| | - Pascal Haigron
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
| | - Pierre Escrig
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
| | - Jacques Tomasi
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
| | - Morgan Daniel
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
| | - Alain Lalande
- ICMUB Laboratory, CNRS 6302, University of Burgundy, 21078 Dijon, France; Medical Imaging Department, University Hospital of Dijon, Dijon, France
| | - Siyu Lin
- ICMUB Laboratory, CNRS 6302, University of Burgundy, 21078 Dijon, France; Medical Imaging Department, University Hospital of Dijon, Dijon, France
| | - Diana Marcela Marin-Castrillon
- ICMUB Laboratory, CNRS 6302, University of Burgundy, 21078 Dijon, France; Medical Imaging Department, University Hospital of Dijon, Dijon, France
| | - Olivier Bouchot
- Department of Cardio-Vascular and Thoracic Surgery, University Hospital of Dijon, Dijon, France
| | - Jean Porterie
- Cardiac Surgery Department, Rangueil University Hospital, Toulouse, France
| | - Pier Paolo Valentini
- University of Rome Tor Vergata, Department of Enterprise Engineering "Mario Lucertini", Rome, Italy
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Luan J, Mao L, Zhu Z, Fu W, Zhu T. New indicators for systematic assessment of aortic morphology: a narrative review. J Thorac Dis 2021; 13:372-383. [PMID: 33569218 PMCID: PMC7867839 DOI: 10.21037/jtd-20-2728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In order to prevent the occurrence of aortic adverse events in ascending thoracic aortic aneurysm patients, preventive surgery is the sole option in case of large aneurysm. Identifying high-risk patients timely and accurately requires effective predictive indicators of aortic adverse events and accurate risk stratification thresholds. Absolute diameter measured after a single imaging examination, which has been used as the predictive indicator for decades, has been proved to be ineffective for risk stratification in moderately dilated aorta. Previously, new indicators combining absolute diameters with personalized parameters have been reported to show better predictive power of aortic adverse events than absolute diameters by correcting the effect of these parameters on the diameters. Meanwhile, combining three-dimensional parameters to formulate risk stratification thresholds not only may characterize the aortic risk morphology more precisely, but also predict aortic adverse events more accurately. These new indicators may provide more systematic assessment methods of patients’ risk, formulate more personalized intervention strategies for ascending thoracic aortic aneurysm patients, and also provide a basis for researchers to develop more accurate and effective risk thresholds. We also highlight that the algorithm obtained by combining multiple indicators may be a better choice compared with single indicator, but this still requires the support of more evidence. Due to the particularity of syndromic aortic disease, whether these new indicators can be used for its risk stratification is still uncertain. Therefore, the scope of this manuscript does not include this kind of disease.
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Affiliation(s)
- Jingyang Luan
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Le Mao
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ziqing Zhu
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ting Zhu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Gaudric J, Politi MT, Fernández JM, Carre E, Capurro C, Fullana JM. Calculation of the aortic arch angles from three-dimensional reconstructions of computed tomography scans: Comparison between an automated program and visual assessment. Comput Biol Med 2019; 114:103440. [DOI: 10.1016/j.compbiomed.2019.103440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 09/06/2019] [Accepted: 09/07/2019] [Indexed: 10/26/2022]
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van Noort K, Schuurmann RCL, Post Hospers G, van der Weijde E, Smeenk HG, Heijmen RH, de Vries JPPM. A New Methodology to Determine Apposition, Dilatation, and Position of Endografts in the Descending Thoracic Aorta After Thoracic Endovascular Aortic Repair. J Endovasc Ther 2019; 26:679-687. [DOI: 10.1177/1526602819859891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To validate computed tomography angiography (CTA)–applied software to assess apposition, dilatation, and position of endografts in the proximal and distal landing zones after thoracic endovascular aortic repair (TEVAR) of thoracic aortic aneurysm. Materials and Methods: Twenty-two patients (median age 75.5 years; 11 men) with a degenerative descending thoracic aortic aneurysm treated with TEVAR with at least one postoperative CTA were selected from a single center’s database. New CTA-applied software was used to determine the available apposition surface in the proximal and distal landing zones, apposition of the endograft fabric with the aortic wall, shortest apposition length, endograft inflow and outflow diameters, shortest distance between the left subclavian artery and the proximal endograft fabric, and shortest distance between the celiac trunk and the distal endograft fabric on each CTA. Interobserver variability for these parameters was assessed with the repeatability coefficient and the intraclass correlation coefficient. Results: Excellent interobserver agreement was found for all measurements. Interobserver variability of surface and shortest apposition length calculations was larger for the distal site compared with the proximal site, with a mean difference of 10% vs 2% of the mean available apposition surface, 12% vs 5% of the endograft apposition surface, and 16% vs 8% of the shortest apposition length, respectively. Inflow and outflow diameters of the endograft showed low variability, with a mean difference of 0.1 mm with 95% of the interobserver difference within 1.8 mm. Mean interobserver differences of the proximal and distal shortest fabric distances were 1.0 and 0.9 mm (both 2% of the mean lengths). Conclusion: Assessment of apposition, dilatation, and position of the proximal and distal parts of an endograft in the descending thoracic aorta is feasible after TEVAR with the new software. Interobserver agreement for all measured parameters was excellent for the proximal and distal landing zones. The new method allows detection of subtle changes during follow-up. However, a larger study is needed to quantify how parameters change over time in complicated and uncomplicated TEVAR cases and to define the real added value of the new methodology.
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Affiliation(s)
- Kim van Noort
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, the Netherlands
| | - Richte C. L. Schuurmann
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, the Netherlands
| | - Gersom Post Hospers
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Emma van der Weijde
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Hans G. Smeenk
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Robin H. Heijmen
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Jean-Paul P. M. de Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, the Netherlands
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