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Sterpetti AV, Marzo LD, Sapienza P, Borrelli V, Cutti S, Bozzani A. Reduced atmospheric levels of PM2.5 and decreased admissions and surgery for Ischemic stroke in Italy. J Stroke Cerebrovasc Dis 2024; 33:107504. [PMID: 38057204 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023] Open
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Bozzani A, Arici V, Di Marzo L, Sterpetti AV. New candidates for screening of abdominal aortic aneurysm outside of current guidelines. J Vasc Surg 2024; 79:452-454. [PMID: 38245188 DOI: 10.1016/j.jvs.2023.07.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 07/28/2023] [Indexed: 01/22/2024]
Affiliation(s)
| | | | - Luca Di Marzo
- Department of Surgery, Sapienza University, Rome, Italy
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Bozzani A, Cutti S, Marzo LD, Gabriele R, Sterpetti AV. Spatio-temporal correlation between admissions for ruptured abdominal aortic aneurysms and levels of atmospheric pollution in Italy. Curr Probl Cardiol 2024; 49:102249. [PMID: 38040214 DOI: 10.1016/j.cpcardiol.2023.102249] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 12/03/2023]
Abstract
AIMS The aim of our study was to determine a correlation between rates and number of patients admitted with ruptured abdominal aortic aneurysms (rAAA) in Italian regions with different levels of atmospheric pollution. METHODS We analyzed a possible correlation between the number and rate (ruptured versus not ruptured) of patients with rAAA admitted in eight Italian regions with different levels of atmospheric pollution. RESULTS Number and rates of patients with rAAA were statistically correlated with levels of air pollution and low air temperature (RR = 1.90, 95% CI: 1.42, 2.1.0) (p<0.01). Even if low temperatures amplified the correlation between admissions for rAAA and PMs exposure, also during Summer and Spring there were sudden increases of the number of admissions for rAAA patients in periods with higher air pollution. The regions with high levels of atmospheric pollution had higher rates of admissions of patients with rAAA in comparison with regions with low level of air pollution. However, there was no difference between regions with low and very low level of atmospheric pollution. Mean age, sex distribution, exposure to established risk factors were similar for the population of the eight analyzed Italian regions. CONCLUSIONS The findings of this study highlight the potential to reduce AAA related mortality and burden by addressing the negative effects of exposure to high levels of atmospheric pollution. The possibility of a dose-dependent effect of atmospheric pollution on the cardiovascular system opens research initiatives and discussions about when and how to modulate interventions to reduce atmospheric pollutants.
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Affiliation(s)
- Antonio Bozzani
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Cutti
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Sterpetti AV, Di Marzo L, Bozzani A. A New Way to Look at Screening for Aortic Aneurysms. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00091-1. [PMID: 38253172 DOI: 10.1016/j.ejvs.2023.08.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 01/24/2024]
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Quaretti P, Corti R, D'Agostino AM, Bozzani A, Moramarco LP, Cionfoli N. Covered stent assisted coil embolization of large Buhler aneurysm in setting of chronic celiac trunk occlusion. CVIR Endovasc 2024; 7:9. [PMID: 38198119 PMCID: PMC10781915 DOI: 10.1186/s42155-023-00416-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/07/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND The arc of Bühler (AOB) is a residual embryonal anastomosis between the celiac artery (CA) and the superior mesenteric artery (SMA). Although usually asymptomatic, it has clinical relevance when compensatory reverse flow between the SMA and the CA in response to celiac artery obstruction leads to aneurysm formation and bleeding. Endovascular coiling is the mainstay therapy because of the deep AOB retropancreatic location, which hinders open surgery. CASE PRESENTATION We herein report a case of a 2.8-cm AOB saccular aneurysm and LAM compression of celiac trunk in a 47-year-old man during rehabilitation following motorcycle trauma and vertebral surgery. The patient was considered unsuitable for surgery. Neither conventional coiling nor bare-metal stent and balloon-assisted techniques for coiling were suitable because of the wide necked saccular shape of AOB aneurysm interposed between the SMA and the floor of celiac trunk. To exclude the aneurysm from direct SMA inflow and permit safe and efficient coiling to rule out retrograde sac perfusion, a 9-mm polytetrafluoroethylene stent graft (Viabahn; Gore, Phoenix, AZ, USA) was positioned in the mesenteric artery, followed by antegrade periprosthetic high-density packed coiling of the aneurysm. The AOB remained excluded from mesenteric perfusion. The patient's clinical condition and abdominal contrast-enhanced multislice computed tomographic findings were unremarkable at the 9-year follow-up. CONCLUSION The 9 year long-term efficacy in our case raises the possibility that perigraft coiling following stent-graft deployment in the SMA may represent a valuable technical option for large Bühler aneurysms that are not amenable to stand-alone coiling.
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Affiliation(s)
- Pietro Quaretti
- Interventional Radiology Unit, Fondazione IRCCS Policlinico San Matteo, V.Le Golgi 19, Pavia, 27100, Italy.
| | - Riccardo Corti
- Interventional Radiology Unit, Fondazione IRCCS Policlinico San Matteo, V.Le Golgi 19, Pavia, 27100, Italy
| | - Antonio Mauro D'Agostino
- Interventional Radiology Unit, Fondazione IRCCS Policlinico San Matteo, V.Le Golgi 19, Pavia, 27100, Italy
| | - Antonio Bozzani
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Paolo Moramarco
- Interventional Radiology Unit, Fondazione IRCCS Policlinico San Matteo, V.Le Golgi 19, Pavia, 27100, Italy
| | - Nicola Cionfoli
- Interventional Radiology Unit, Fondazione IRCCS Policlinico San Matteo, V.Le Golgi 19, Pavia, 27100, Italy
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Sterpetti AV, Arici V, Franciscone M, D'Ermo G, Di Marzo L, Carati MV, Costi U, Ragni F, Arbustini E, Bozzani A. Heterogeneous Characteristics of Patients with Inflammatory Abdominal Aortic Aneurysm. Systematic Review of Therapeutic Solutions. Ann Vasc Surg 2023; 97:311-319. [PMID: 37454897 DOI: 10.1016/j.avsg.2023.06.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Endovascular repair of inflammatory abdominal aortic aneurysms (IAAAs) has emerged as an alternative to open surgery, but direct comparisons are limited. The aim of the study was to compare clinical outcomes of endovascular and open repair for IAAA according with specific clinical characteristics. METHODS We performed a literature review of reports describing patients who had open or endovascular repair for IAAA. A literature search was performed in June 2022 by 2 investigators who conducted a review of papers reported in PubMed, Embase, MEDLINE, and Cochrane Database. The strings "Inflammatory aneurysm" and "Abdominal Aortic Aneurysms" were used. There was no language restriction and screened reports were published from March 1972 to December 2021. We identified 2,062 patients who had open (1,586) or endovascular repair (476) for IAAA. Primary outcomes were operative mortality and morbidity. Secondary outcomes were complications during follow-up (mean follow-up: 48 months). Propensity score matching was performed between patients who had open or endovascular surgery. RESULTS In Western countries, propensity-weighted postoperative mortality (in-hospital) (1.5% endovascular vs. 6% open) and morbidity rates (6% vs. 18%) were significantly lower in patients who had endovascular repair (P < 0.0001); patients with larger aneurysm (more than 7 cm diameter), signs of active inflammation, and retroperitoneal rupture of the aneurysm had better outcomes after endovascular repair than after open surgery. Hydronephrosis was present in 20% of the patients. Hydronephrosis regressed in most patients when signs of active inflammation were present suggesting an acute onset of the hydronephrosis itself (fever, elevated serum C Reactive Protein) either after endovascular or open surgery. Long-standing hydronephrosis as suggested by the absence of signs of active inflammation rarely regressed after endovascular surgery despite associated steroid therapy. During a mean follow-up of 48 months, propensity-weighted graft-related complications were more common in patients who had endovascular repair (20% vs. 8%). For patients from Asia, short-term and medium-term results were similar after open and endovascular repair. IAAAs related with aortitis were more common in Asia. In Western countries, IAAAs were commonly associated with atherosclerosis. CONCLUSIONS Patients with IAAA represent a heterogeneous population, suggesting biological differences from continent to continent; conservative therapy and endovascular or open surgery should be chosen according to the patient clinical condition. Endovascular repair presents advantages in patients with signs of active inflammation and contained rupture of the IAAA and larger aneurysms. Hydronephrosis, without signs of active inflammation, rarely regresses after endovascular repair associated with steroid therapy. Further studies are needed to establish the long-term results of endovascular repair.
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Bozzani A, Arici V, Tavazzi G, Ragni F, Mojoli F, Cavallini E, Vugt FV, Cutti S, Figini S, Venturi A, Sterpetti AV, Arbustini E. Trends (2020-2022) toward Reduced Prevalence of Postcoronavirus Disease Syndrome and Improved Quality of Life for Hospitalized Coronavirus Disease 2019 Patients with Severe Infection and Venous Thromboembolism. Semin Thromb Hemost 2023. [PMID: 37832585 DOI: 10.1055/s-0043-1776004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic seems to be at its end. During the first outbreak, alfa was the dominant variant, and in the two following years, delta was the dominant variant. Questions remain about the prevalence and severity of post-COVID syndrome (PCS). We compared the medium-term outcomes of a selected group of patients considered at high risk for PCS: hospitalized patients with severe COVID-19 infection who presented clinical evidence of the acute onset of venous thromboembolism. Weighted Cox regression was used to estimate the adjusted hazard ratios for the risk of early and medium-term complications and quality of life (QoL) in COVID-19 patients developing acute venous thrombo-embolism according to the period of admission to the hospital. The primary outcome was the modification of QoL at a median follow-up of 24 months in patients hospitalized for COVID-19. The secondary outcome was the modification of QoL related to COVID-19 severity. The absolute risk of mortality for hospitalized COVID-19 patients was higher during the first outbreak (risk difference, 19% [95% confidence interval [CI], 16-22%]). Patients with acute onset of thromboembolism during the first outbreak had increased mortality, hospital stay, and need for intensive care unit treatment (p < 0.01). In patients who suffered from severe COVID-19 infection and thromboembolism in the following 2 years, symptoms during follow-up were less common and milder (risk difference 45% [95% CI, 40-52%]. In total, 19 patients were alive at 24 months follow-up: 12 patients (63%) reported important physical symptoms and 10 patients (52%) relevant emotional/mental symptoms. All patients reported reduced QoL in comparison with the preinfection time; in 15 patients (79%), the reduced QoL limited significantly their social and work activities. All patients reported permanent worsening of QoL after discharge from the hospital. Comparing the three different February to April interval years (2020, 2021, and 2022), patients reported a somewhat worse perception of health condition in comparison with the preinfection time, respectively, in 100, 79, and 56% respectively. The findings of our study show reduced prevalence and severity of PCS in the last 2 years. Less virulent variants, herd immunity, and vaccination may played a significant role.
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Affiliation(s)
- Antonio Bozzani
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vittorio Arici
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Guido Tavazzi
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Medical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy
| | - Franco Ragni
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Mojoli
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Medical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy
| | - Elena Cavallini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Floris van Vugt
- Department of Psychology, University of Montreal, Centre-ville Montréal, Canada
| | - Sara Cutti
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Figini
- Department of Political and Social Sciences, University of Pavia, Pavia, Italy
| | | | | | - Eloisa Arbustini
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Bozzani A, Arici V, Sterpetti AV. Re: Stenting of the Superficial Femoral Artery for Intermittent Claudication. Eur J Vasc Endovasc Surg 2023; 65:913. [PMID: 36933647 DOI: 10.1016/j.ejvs.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Antonio Bozzani
- Vascular Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vittorio Arici
- Vascular Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Bozzani A, Arici V, Sterpetti AV. Telemedicine for Endovascular Aneurysm Repair Surveillance. Eur J Vasc Endovasc Surg 2023; 65:915. [PMID: 36967014 DOI: 10.1016/j.ejvs.2023.02.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/21/2023] [Indexed: 05/13/2023]
Affiliation(s)
- Antonio Bozzani
- Vascular Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vittorio Arici
- Vascular Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Bozzani A, Sterpetti AV, Arici V, Ragni F, Arbustini E. Air Pollution and Rupture of Abdominal Aortic Aneurysms. J Am Coll Cardiol 2023; 81:e99. [PMID: 36948742 DOI: 10.1016/j.jacc.2022.12.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/05/2022] [Indexed: 03/24/2023]
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Martelli E, Zamboni M, Sotgiu G, Saderi L, Federici M, Sangiorgi GM, Puci MV, Martelli AR, Messina T, Frigatti P, Borrelli MP, Ruotolo C, Ficarelli I, Rubino P, Pezzo F, Carbonari L, Angelini A, Galeazzi E, Di Pinto LC, Fiore FM, Palmieri A, Ventoruzzo G, Mazzitelli G, Ragni F, Bozzani A, Forliti E, Castagno C, Volpe P, Massara M, Moniaci D, Pagliasso E, Peretti T, Ferrari M, Troisi N, Modugno P, Maiorano M, Bracale UM, Panagrosso M, Monaco M, Giordano G, Natalicchio G, Biello A, Celoria GM, Amico A, Di Bartolo M, Martelli M, Munaó R, Razzano D, Colacchio G, Bussetti F, Lanza G, Cardini A, Di Benedetto B, De Laurentis M, Taurino M, Sirignano P, Cappiello P, Esposito A, Trimarchi S, Romagnoli S, Padricelli A, Giudice G, Crinisio A, Di Nardo G, Battaglia G, Tringale R, De Vivo S, Compagna R, Tolva VS, D’Alessio I, Curci R, Giovannetti S, D’Arrigo G, Basile G, Frigerio D, Veraldi GF, Mezzetto L, Ippoliti A, Oddi FM, Settembrini AM. Sex-Related Differences and Factors Associated with Peri-Procedural and 1 Year Mortality in Chronic Limb-Threatening Ischemia Patients from the CLIMATE Italian Registry. J Pers Med 2023; 13:jpm13020316. [PMID: 36836550 PMCID: PMC9959358 DOI: 10.3390/jpm13020316] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Identifying sex-related differences/variables associated with 30 day/1 year mortality in patients with chronic limb-threatening ischemia (CLTI). METHODS Multicenter/retrospective/observational study. A database was sent to all the Italian vascular surgeries to collect all the patients operated on for CLTI in 2019. Acute lower-limb ischemia and neuropathic-diabetic foot are not included. FOLLOW-UP One year. Data on demographics/comorbidities, treatments/outcomes, and 30 day/1 year mortality were investigated. RESULTS Information on 2399 cases (69.8% men) from 36/143 (25.2%) centers. Median (IQR) age: 73 (66-80) and 79 (71-85) years for men/women, respectively (p < 0.0001). Women were more likely to be over 75 (63.2% vs. 40.1%, p = 0.0001). More men smokers (73.7% vs. 42.2%, p < 0.0001), are on hemodialysis (10.1% vs. 6.7%, p = 0.006), affected by diabetes (61.9% vs. 52.8%, p < 0.0001), dyslipidemia (69.3% vs. 61.3%, p < 0.0001), hypertension (91.8% vs. 88.5%, p = 0.011), coronaropathy (43.9% vs. 29.4%, p < 0.0001), bronchopneumopathy (37.1% vs. 25.6%, p < 0.0001), underwent more open/hybrid surgeries (37.9% vs. 28.8%, p < 0.0001), and minor amputations (22% vs. 13.7%, p < 0.0001). More women underwent endovascular revascularizations (61.6% vs. 55.2%, p = 0.004), major amputations (9.6% vs. 6.9%, p = 0.024), and obtained limb-salvage if with limited gangrene (50.8% vs. 44.9%, p = 0.017). Age > 75 (HR = 3.63, p = 0.003) is associated with 30 day mortality. Age > 75 (HR = 2.14, p < 0.0001), nephropathy (HR = 1.54, p < 0.0001), coronaropathy (HR = 1.26, p = 0.036), and infection/necrosis of the foot (dry, HR = 1.42, p = 0.040; wet, HR = 2.04, p < 0.0001) are associated with 1 year mortality. No sex-linked difference in mortality statistics. CONCLUSION Women exhibit fewer comorbidities but are struck by CLTI when over 75, a factor associated with short- and mid-term mortality, explaining why mortality does not statistically differ between the sexes.
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Affiliation(s)
- Eugenio Martelli
- Department of General and Specialist Surgery Paride Stefanini, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 155 viale del Policlinico, 00161 Rome, Italy
- Medicine and Surgery School of Medicine, Saint Camillus International University of Health Sciences, 8 via di Sant’Alessandro, 00131 Rome, Italy
- Division of Vascular Surgery, Department of Cardiovascular Sciences, S. Anna and S. Sebastiano Hospital, via F. Palasciano, 81100 Caserta, Italy
- Correspondence: ; Tel.: +39-3294003220
| | - Matilde Zamboni
- Division of Vascular Surgery, Saint Martin Hospital, 22 viale Europa, 32100 Belluno, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, viale San Pietro, 07100 Sassari, Italy
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, viale San Pietro, 07100 Sassari, Italy
| | - Massimo Federici
- Department of Systems Medicine, University of Rome Tor Vergata, 1 viale Montpellier, 00133 Rome, Italy
| | - Giuseppe M. Sangiorgi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 1 viale Montpellier, 00133 Rome, Italy
| | - Mariangela V. Puci
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, viale San Pietro, 07100 Sassari, Italy
| | - Allegra R. Martelli
- Medicine and Surgery School of Medicine, Campus Bio-Medico University of Rome, 21 via À. del Portillo, 00128 Rome, Italy
| | - Teresa Messina
- Division of Anesthesia and Intensive Care of Organ Transplants, Umberto I Polyclinic University Hospital, 155 viale del Policlinico, 00161 Rome, Italy
| | - Paolo Frigatti
- Divisions of Vascular Surgery, S. Maria Misericordia University Hospital, 15 Piazzale Santa Maria della Misericordia, 33100 Udine, Italy
| | - Maria Pia Borrelli
- Divisions of Vascular Surgery, S. Maria Misericordia University Hospital, 15 Piazzale Santa Maria della Misericordia, 33100 Udine, Italy
| | - Carlo Ruotolo
- Divisions of Vascular Surgery, Cardarelli Hospital, 9 Via A. Cardarelli, 80131 Naples, Italy
| | - Ilaria Ficarelli
- Divisions of Vascular Surgery, Cardarelli Hospital, 9 Via A. Cardarelli, 80131 Naples, Italy
| | - Paolo Rubino
- Divisions of Vascular Surgery, Pugliese Ciaccio Hospital, 83 viale Pio X, 88100 Catanzaro, Italy
| | - Francesco Pezzo
- Divisions of Vascular Surgery, Pugliese Ciaccio Hospital, 83 viale Pio X, 88100 Catanzaro, Italy
| | - Luciano Carbonari
- Divisions of Vascular Surgery, Riuniti University Hospitals, 71 via Conca, Torrette (AN), 60126 Ancona, Italy
| | - Andrea Angelini
- Divisions of Vascular Surgery, Riuniti University Hospitals, 71 via Conca, Torrette (AN), 60126 Ancona, Italy
| | - Edoardo Galeazzi
- Divisions of Vascular Surgery, Treviso Hospital, 1 piazzale del’Ospedale, 31100 Treviso, Italy
| | - Luca Calia Di Pinto
- Divisions of Vascular Surgery, Treviso Hospital, 1 piazzale del’Ospedale, 31100 Treviso, Italy
| | - Franco M. Fiore
- Divisions of Vascular Surgery, SS. Annunziata Hospital, 31 via dei Vestini, 66100 Chieti, Italy
| | - Armando Palmieri
- Divisions of Vascular Surgery, SS. Annunziata Hospital, 31 via dei Vestini, 66100 Chieti, Italy
| | - Giorgio Ventoruzzo
- Divisions of Vascular Surgery, San Donato Hospital, 20 via Pietro Nenni, 52100 Arezzo, Italy
| | - Giulia Mazzitelli
- Divisions of Vascular Surgery, San Donato Hospital, 20 via Pietro Nenni, 52100 Arezzo, Italy
| | - Franco Ragni
- Divisions of Vascular Surgery, San Matteo Polyclinic, 19 viale Camillo Golgi, 27100 Pavia, Italy
| | - Antonio Bozzani
- Divisions of Vascular Surgery, San Matteo Polyclinic, 19 viale Camillo Golgi, 27100 Pavia, Italy
| | - Enzo Forliti
- Divisions of Vascular Surgery, Infermi Hospital, Via dei Ponderanesi 2, 13875 Ponderano, Italy
| | - Claudio Castagno
- Divisions of Vascular Surgery, Infermi Hospital, Via dei Ponderanesi 2, 13875 Ponderano, Italy
| | - Pietro Volpe
- Divisions of Vascular Surgery, Bianchi-Melacrino-Morelli Hospital, 21 via G. Melacrino, 89124 Reggio di Calabria, Italy
| | - Mafalda Massara
- Divisions of Vascular Surgery, Bianchi-Melacrino-Morelli Hospital, 21 via G. Melacrino, 89124 Reggio di Calabria, Italy
| | - Diego Moniaci
- Divisions of Vascular Surgery, San Giovanni Bosco Hospital, 3 piazza del Donatore di Sangue, 10154 Turin, Italy
| | - Elisa Pagliasso
- Divisions of Vascular Surgery, San Giovanni Bosco Hospital, 3 piazza del Donatore di Sangue, 10154 Turin, Italy
| | - Tania Peretti
- Divisions of Vascular Surgery, San Giovanni Bosco Hospital, 3 piazza del Donatore di Sangue, 10154 Turin, Italy
| | - Mauro Ferrari
- Divisions of Vascular Surgery, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 2 via Paradisa, 56124 Pisa, Italy
| | - Nicola Troisi
- Divisions of Vascular Surgery, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 2 via Paradisa, 56124 Pisa, Italy
| | - Piero Modugno
- Divisions of Vascular Surgery, Gemelli Molise Hospital, 1 largo A. Gemelli, 86100 Campobasso, Italy
| | - Maurizio Maiorano
- Divisions of Vascular Surgery, Gemelli Molise Hospital, 1 largo A. Gemelli, 86100 Campobasso, Italy
| | - Umberto M. Bracale
- Divisions of Vascular Surgery, Federico II Polyclinic, Department of Public Health and Residency Program in Vascular Surgery, University of Naples Federico II, 5 via S. Pansini, 80131 Naples, Italy
| | - Marco Panagrosso
- Divisions of Vascular Surgery, Federico II Polyclinic, Department of Public Health and Residency Program in Vascular Surgery, University of Naples Federico II, 5 via S. Pansini, 80131 Naples, Italy
| | - Mario Monaco
- Divisions of Vascular Surgery, Pineta Grande Hospital, Km. 30 via Domitiana, 81030 Castelvolturno, Italy
- Divisions of Vascular Surgery, Sanatrix Clinic, 31 via S. Domenico, 80127 Naples, Italy
| | - Giovanni Giordano
- Divisions of Vascular Surgery, Sanatrix Clinic, 31 via S. Domenico, 80127 Naples, Italy
| | - Giuseppe Natalicchio
- Divisions of Vascular Surgery, Venere Hospital, 1 via Ospedale di Venere, 70131 Bari, Italy
| | - Antonella Biello
- Divisions of Vascular Surgery, Venere Hospital, 1 via Ospedale di Venere, 70131 Bari, Italy
| | - Giovanni M. Celoria
- Divisions of Vascular Surgery, Sant’Andrea Hospital, 197 via Vittorio Veneto, 19121 La Spezia, Italy
| | - Alessio Amico
- Divisions of Vascular Surgery, Sant’Andrea Hospital, 197 via Vittorio Veneto, 19121 La Spezia, Italy
| | - Mauro Di Bartolo
- Divisions of Vascular Surgery, Sant’Andrea Hospital, 197 via Vittorio Veneto, 19121 La Spezia, Italy
| | - Massimiliano Martelli
- Divisions of Vascular Surgery, MultiMedica Hospital, 300 via Milenese, 20099 Sesto San Giovanni, Italy
| | - Roberta Munaó
- Divisions of Vascular Surgery, MultiMedica Hospital, 300 via Milenese, 20099 Sesto San Giovanni, Italy
| | - Davide Razzano
- Divisions of Vascular Surgery, San Pio Hospital, 1 via dell’angelo, 82100 Benevento, Italy
| | - Giovanni Colacchio
- Divisions of Vascular Surgery, F.Miulli Hospital, Strada Prov. 127 Acquaviva-Santeramo Km. 4, 70021 Acquaviva delle Fonti, Italy
| | - Francesco Bussetti
- Divisions of Vascular Surgery, F.Miulli Hospital, Strada Prov. 127 Acquaviva-Santeramo Km. 4, 70021 Acquaviva delle Fonti, Italy
| | - Gaetano Lanza
- Divisions of Vascular Surgery, Multimedica Hospital, 70 viale Piemonte, 21053 Castellanza, Italy
| | - Antonio Cardini
- Divisions of Vascular Surgery, Multimedica Hospital, 70 viale Piemonte, 21053 Castellanza, Italy
| | | | - Mario De Laurentis
- Divisions of Vascular Surgery, Monaldi Hospital, via L. Bianchi, 84100 Naples, Italy
| | - Maurizio Taurino
- Divisions of Vascular Surgery, Department of Molecular and Clinical Medicine, Sapienza University of Rome, Giorgio Nicola Papanicolau, 00189 Rome, Italy
- Divisions of Vascular Surgery, Sant’Andrea University Hospital, 1035/1039 via di Grottarossa, 00189 Rome, Italy
| | - Pasqualino Sirignano
- Department of General and Specialist Surgery Paride Stefanini, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 155 viale del Policlinico, 00161 Rome, Italy
- Divisions of Vascular Surgery, Sant’Andrea University Hospital, 1035/1039 via di Grottarossa, 00189 Rome, Italy
| | - Pierluigi Cappiello
- Divisions of Vascular Surgery, San Carlo Hospital, via Potito Petrone, 85100 Potenza, Italy
| | - Andrea Esposito
- Divisions of Vascular Surgery, San Carlo Hospital, via Potito Petrone, 85100 Potenza, Italy
| | - Santi Trimarchi
- Divisions of Vascular Surgery, Department of Clinical and Community Sciences, University of Milan, 19 via della Commenda, 20122 Milan, Italy
- Divisions of Vascular Surgery, Maggiore Polyclinic Hospital Ca’ Granda IRCCS and Foundation, 35 via Francesco Sforza, 20122 Milan, Italy
| | - Silvia Romagnoli
- Divisions of Vascular Surgery, Maggiore Polyclinic Hospital Ca’ Granda IRCCS and Foundation, 35 via Francesco Sforza, 20122 Milan, Italy
| | - Andrea Padricelli
- Division of Vascular Surgery, Department of Cardiovascular Sciences, S. Anna and S. Sebastiano Hospital, via F. Palasciano, 81100 Caserta, Italy
| | - Giorgio Giudice
- Division of Vascular Surgery, Department of Cardiovascular Sciences, S. Anna and S. Sebastiano Hospital, via F. Palasciano, 81100 Caserta, Italy
| | - Adolfo Crinisio
- Divisions of Vascular Surgery, Salus Clinic, 4 via F. Confalonieri, 84091 Battipaglia, Italy
| | - Giovanni Di Nardo
- Divisions of Vascular Surgery, Salus Clinic, 4 via F. Confalonieri, 84091 Battipaglia, Italy
| | - Giuseppe Battaglia
- Divisions of Vascular Surgery, San Marco Hospital, viale Carlo Azeglio Ciampi, 95121 Catania, Italy
| | - Rosario Tringale
- Divisions of Vascular Surgery, San Marco Hospital, viale Carlo Azeglio Ciampi, 95121 Catania, Italy
| | - Salvatore De Vivo
- Divisions of Vascular Surgery, Pellegrini Hospital, 41 via Portamedina alla Pignasecca, 80134 Naples, Italy
| | - Rita Compagna
- Divisions of Vascular Surgery, Pellegrini Hospital, 41 via Portamedina alla Pignasecca, 80134 Naples, Italy
| | - Valerio S. Tolva
- Divisions of Vascular Surgery, Niguarda Hospital, Piazza dell’Ospedale Maggiore 3, 20161 Milan, Italy
| | - Ilenia D’Alessio
- Divisions of Vascular Surgery, Niguarda Hospital, Piazza dell’Ospedale Maggiore 3, 20161 Milan, Italy
| | - Ruggiero Curci
- Divisions of Vascular Surgery, Maggiore Hospital, 10 Piazza Ospitale, 26900 Lodi, Italy
| | - Simona Giovannetti
- Divisions of Vascular Surgery, Maggiore Hospital, 10 Piazza Ospitale, 26900 Lodi, Italy
| | - Giuseppe D’Arrigo
- Divisions of Vascular Surgery, Garibaldi-Nesima Hospital, 636 via Palermo, 95122 Catania, Italy
| | - Giusi Basile
- Divisions of Vascular Surgery, Garibaldi-Nesima Hospital, 636 via Palermo, 95122 Catania, Italy
| | - Dalmazio Frigerio
- Divisions of Vascular Surgery, Vimercate Hospital, 10 via Cosma e Damiano, 20871 Vimercate, Italy
| | - Gian Franco Veraldi
- Divisions of Vascular Surgery, University Hospital Pietro Confortini, 1 Piazzale Aristide Stefani, 37126 Verona, Italy
| | - Luca Mezzetto
- Divisions of Vascular Surgery, University Hospital Pietro Confortini, 1 Piazzale Aristide Stefani, 37126 Verona, Italy
| | - Arnaldo Ippoliti
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 1 viale Montpellier, 00133 Rome, Italy
| | - Fabio M. Oddi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 1 viale Montpellier, 00133 Rome, Italy
| | - Alberto M. Settembrini
- Divisions of Vascular Surgery, Maggiore Polyclinic Hospital Ca’ Granda IRCCS and Foundation, 35 via Francesco Sforza, 20122 Milan, Italy
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Bozzani A, Arici V, Ragni F, Sterpetti A, Arbustini E. Intravenous thrombolysis before mechanical thrombectomy in patients with atrial fibrillation. J Neurointerv Surg 2022:jnis-2022-019749. [DOI: 10.1136/jnis-2022-019749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/04/2022]
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13
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Sterpetti AV, Arici V, Bozzani A. Cancer and the vascular surgeon. J Vasc Surg 2022; 76:1109. [PMID: 36150775 DOI: 10.1016/j.jvs.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/12/2022] [Accepted: 05/23/2022] [Indexed: 10/14/2022]
Affiliation(s)
| | - Vittorio Arici
- Department of Surgery, University of Rome Sapienza, Rome, Italy
| | - Antonio Bozzani
- Department of Surgery, University of Rome Sapienza, Rome, Italy
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14
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Sterpetti AV, Arici V, Bozzani A. Ischemic Stroke in Patients With Asymptomatic Severe Carotid Stenosis Without Surgical Intervention. JAMA 2022; 328:1255-1256. [PMID: 36166038 DOI: 10.1001/jama.2022.13007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Vittorio Arici
- Department of Surgery, University of Rome Sapienza, Rome, Italy
| | - Antonio Bozzani
- Department of Surgery, University of Rome Sapienza, Rome, Italy
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15
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Bozzani A, Farè C, Arici V, Ragni F, Quaretti P, Sterpetti AV. Aortic septotomy with scissor-technique. JTCVS Tech 2022; 16:14-15. [PMID: 36510537 PMCID: PMC9735318 DOI: 10.1016/j.xjtc.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Antonio Bozzani
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Camilla Farè
- General Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vittorio Arici
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Franco Ragni
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Pietro Quaretti
- Interventional Radiology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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16
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Bozzani A, Arici V, Ragni F, Sterpetti AV, Quaretti P, Arbustini E. Re: "The Impact of Degenerative Connective Tissue Disorders on Outcomes Following Endovascular Aortic Intervention in the Global Registry for Endovascular Aortic Treatment". Ann Vasc Surg 2022; 83:e3-e4. [PMID: 35337929 DOI: 10.1016/j.avsg.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/04/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Antonio Bozzani
- Vascular and Endovascular Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, ITALY.
| | - Vittorio Arici
- Vascular and Endovascular Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, ITALY
| | - Franco Ragni
- Vascular and Endovascular Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, ITALY
| | | | - Pietro Quaretti
- Interventional Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, ITALY
| | - Eloisa Arbustini
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Department of Medical Sciences and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, ITALY
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17
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Bozzani A, Arici V, Ticozzelli G, Franciscone MM, Sterpetti AV, Ragni F. Sudden Rupture of Abdominal Aortic Aneurysm in COVID19 Patients. J Endovasc Ther 2022; 30:296-301. [PMID: 35098775 PMCID: PMC10051004 DOI: 10.1177/15266028221075221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: The purpose of the paper is to report the clinical outcomes of 4 patients with ruptured abdominal aortic aneurysm (AAA) during (3 patients) or immediately after (1 patient) moderate-severe SARS-CoV-2 infection. We discuss COVID-19-related mechanisms which could impact AAA rupture. Patients and Methods: During the period of the pandemic (March 2020—May 2021), we performed surgery in 18 patients with ruptured AAA. Four patients were affected by moderate or severe SARS-CoV-2 infection (in 3 patients the rupture occurred during the infection and in 1 patient 3. months after discharge from the hospital). Two patients underwent open repair and 2 endovascular surgery. Results: No postoperative mortality and no major complication occurred. Rapid growth of the AAA in comparison with a previous Duplex scan was evident in all 4 patients. Conclusions: Family doctors and vascular surgeons should be aware about the possibility of AAA degeneration in patients with moderate-severe COVID19 infection. The risk is increased by steroid therapy which is essential in more advanced stages of the infection. In this clinical setting, endovascular repair is a valid choice.
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Affiliation(s)
- Antonio Bozzani
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vittorio Arici
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulia Ticozzelli
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mila Maria Franciscone
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Franco Ragni
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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18
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Bozzani A, Arici V, Ticozzelli G, Franciscone MM, Ragni F, Sterpetti AV. Reduced Vascular Practice and Increased Cardiovascular Mortality for COVID-19-Negative Patients. J Surg Res 2021; 272:146-152. [PMID: 34973548 PMCID: PMC8654577 DOI: 10.1016/j.jss.2021.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/15/2021] [Accepted: 11/25/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The aim of our study was to compare COVID-19- and not-COVID-19-related mortality rates in two Italian regions during the pandemic period when the same isolation rules and therapeutic approaches were introduced for all hospitals in Italy. Risk factors for not-COVID-19-related deaths during the pandemic were analyzed; we tried to assess a possible correlation between reducing hospital visits and "deferrable" vascular operations and the increased cardiovascular mortality not related to COVID-19 infection. METHODS We analyzed COVID-19- and not-COVID-19-related mortality rates in two Italian regions in the period January 2020-January 2021. We compared mortality rates during the pandemic period with those of the previous five years. We tried to determine the factors involved in increased mortality rates during the pandemic period. RESULTS Despite the same isolation rules for people and the same therapeutic approaches for hospitals, mortality rates did not increase in the region Lazio, where the pandemic was not severe. In the region Lombardy, the mortality rate was doubled in comparison with the previous years, and 50% of the increase was related to not-COVID-19 deaths. CONCLUSIONS The increase in mortality rates for not-COVID-19-related deaths in the region Lombardy was connected to the generalized turmoil in the acute phase of an overwhelming pandemic, including diffuse stress, inadequate communications, reluctance to ask for medical help unless symptoms were severe, and unexpected inadequate number of health workers, hospital beds, and intensive care unit beds. Reduced hospital visits may have had a fundamental role.
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Affiliation(s)
- Antonio Bozzani
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vittorio Arici
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulia Ticozzelli
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mila Maria Franciscone
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Franco Ragni
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Bozzani A, Arici V, Ticozzelli G, Franciscone MM, Sterpetti AV, Ragni F. Increased rates of ruptured abdominal aortic aneurysm during the COVID-19 pandemic. J Vasc Surg 2021; 74:2119-2120. [PMID: 34809819 PMCID: PMC8828365 DOI: 10.1016/j.jvs.2021.07.224] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/31/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Antonio Bozzani
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vittorio Arici
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulia Ticozzelli
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mila Maria Franciscone
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio V Sterpetti
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Franco Ragni
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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20
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Bozzani A, Arici V, Franciscone M, Ticozzelli G, Sterpetti AV, Ragni F. COVID-19 patients with abdominal aortic aneurysm may be at higher risk for sudden enlargement and rupture. J Vasc Surg 2021; 75:387-388. [PMID: 34774979 PMCID: PMC8582098 DOI: 10.1016/j.jvs.2021.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/04/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Antonio Bozzani
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS San Matteo, Pavia, Italy
| | - Vittorio Arici
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS San Matteo, Pavia, Italy
| | | | - Giulia Ticozzelli
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS San Matteo, Pavia, Italy
| | - Antonio V Sterpetti
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS San Matteo, Pavia, Italy
| | - Franco Ragni
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS San Matteo, Pavia, Italy
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21
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Arici V, Boschini S, Fellegara R, Carando S, Rossi M, Ragni F, Bozzani A. "Re: "Outcomes and Predictors of Mortality in a Belgian Population of Patients Admitted With Ruptured Abdominal Aortic Aneurysm and Treated by Open Repair in the Contemporary Era". Ann Vasc Surg 2021; 79:e7-e8. [PMID: 34648857 DOI: 10.1016/j.avsg.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/29/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Vittorio Arici
- Vascular and Endovascular Surgery, Foundation I.R.C.C.S., Pavia, Italy
| | - Stefano Boschini
- Vascular and Endovascular Surgery, Foundation I.R.C.C.S., Pavia, Italy
| | | | - Simona Carando
- Vascular and Endovascular Surgery, Foundation I.R.C.C.S., Pavia, Italy
| | - Mauro Rossi
- Vascular and Endovascular Surgery, Foundation I.R.C.C.S., Pavia, Italy
| | - Franco Ragni
- Vascular and Endovascular Surgery, Foundation I.R.C.C.S., Pavia, Italy
| | - Antonio Bozzani
- Vascular and Endovascular Surgery, Foundation I.R.C.C.S., Pavia, Italy.
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22
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Abstract
The term Long COVID (or Post COVID) describes a condition characterized by persistence of symptoms for at least 12 weeks after the onset of COVID-19. It may last several months but the duration is still matter of observation. The symptoms and the clinical manifestations are clinically heterogeneous and suggesting involvement of multi-organs/systems, including the cardiovascular system. The general recurrent symptoms include fatigue, breathlessness, myalgia, headache, loss of memory, and impaired concentration. Patients report loss of their previous psychophysical performance. Cardiovascular involvement manifests with common symptoms such as palpitations and chest pain, and, less commonly, with events such as late arterial and venous thromboembolisms, heart failure episodes, strokes or transient ischaemic attack, 'myo-pericarditis'. The diagnostic criteria are mainly based on the narrative of the patients. Measurable biomarkers or instrumental findings or clinical events are not yet framed in a shared diagnostic framework. The open question for clinicians and researchers is whether biomarkers, electrocardiogram, non-invasive imaging, and clinical monitoring should be included in a shared diagnostic protocol aimed at defining the diagnostic path and protecting patients at risk of unexpected events.
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Affiliation(s)
- Alessandro Di Toro
- Department of Medical Sciences and Infectious Diseases, Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Fondazione IRCCS Policlinico San Matteo, Piazzale Camillo Golgi 19, 27100 Pavia, Italy
| | - Antonio Bozzani
- Department of Surgical Science, Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Guido Tavazzi
- Anaesthesia and Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Mario Urtis
- Department of Medical Sciences and Infectious Diseases, Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Fondazione IRCCS Policlinico San Matteo, Piazzale Camillo Golgi 19, 27100 Pavia, Italy
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Lorenzo Giuliani
- Department of Medical Sciences and Infectious Diseases, Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Fondazione IRCCS Policlinico San Matteo, Piazzale Camillo Golgi 19, 27100 Pavia, Italy
| | - Roberto Pizzoccheri
- Department of Medical Sciences and Infectious Diseases, Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Fondazione IRCCS Policlinico San Matteo, Piazzale Camillo Golgi 19, 27100 Pavia, Italy
| | - Flaminia Aliberti
- Department of Medical Sciences and Infectious Diseases, Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Fondazione IRCCS Policlinico San Matteo, Piazzale Camillo Golgi 19, 27100 Pavia, Italy
| | - Viola Fergnani
- Department of Medical Sciences and Infectious Diseases, Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Fondazione IRCCS Policlinico San Matteo, Piazzale Camillo Golgi 19, 27100 Pavia, Italy
| | - Eloisa Arbustini
- Department of Medical Sciences and Infectious Diseases, Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Fondazione IRCCS Policlinico San Matteo, Piazzale Camillo Golgi 19, 27100 Pavia, Italy
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23
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Bozzani A, Arici V, Ticozzelli G, Pregnolato S, Boschini S, Fellegara R, Carando S, Ragni F, Sterpetti AV. Intraoperative Cerebral Monitoring During Carotid Surgery: A Narrative Review. Ann Vasc Surg 2021; 78:36-44. [PMID: 34537350 DOI: 10.1016/j.avsg.2021.06.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Intra-operative neurological monitoring (IONM) during carotid endarterectomy (CEA) aims to reduce neurological morbidity of surgery. OBJECTIVE This narrative review analyses the role and results of different methods of IONM. METHODS review articles on PUBMED and Cochrane Library, by searching key words related to IONM and CEA, from 2000 up to date. RESULTS regional anesthesia in some centers represents the "gold standard". The most often used alternative techniques are: stump pressure, electroencephalogram, somatosensory evoked potentials, transcranical doppler ultrasound, near infrared spectroscopy and routine shunting. Every technique shows limitations. Regional anesthesia can make difficult prompt intubation when needed. Stump pressure shows a wide operative range. Electroencephalogram is unable to detect ischemia in sub-cortical regions of the brain. Somatosensory evoked potentials certainly demonstrate the presence of cerebral ischemia, but are no more specific or sensitive than the electroencephalogram. Transcranical doppler monitoring is undoubtedly operator-dependent and suffers from the limitations that the probe has to be placed relatively near to the surgical site and may impede the operator, especially if it needs constant adjustments; moreover, an acoustic window may not be found in 10% -20% of the subjects. Near infrared spectroscopy appears to have a high negative predictive value for cerebral ischemia, but has a poor positive predictive value and low specificity, because predominantly estimates venous oxygenation as this makes up about 80% of cerebral blood volume. The data on the use of Routine Shunting (RS) from RCTs are limited. CONCLUSIONS currently, with no clear consensus on monitoring technique, choice should be guided by local expertise and complication rates. With reflection, best practice may dictate that a standard technique is selected as suggested above and this remains the default position for individual practice. Nevertheless, current techniques for monitoring cerebral perfusion during CEA are associated with false negative and false positive resulting in inappropriate shunt insertion.
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Affiliation(s)
- Antonio Bozzani
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Vittorio Arici
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulia Ticozzelli
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sandro Pregnolato
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefano Boschini
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Raffaele Fellegara
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Simona Carando
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Franco Ragni
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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24
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Bozzani A, Sterpetti AV, Ragni F. Aberrant right subclavian artery: multiple solutions for a complex anomaly of the aortic arch. Ann Thorac Surg 2021; 114:1091-1092. [PMID: 34419442 DOI: 10.1016/j.athoracsur.2021.07.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Antonio Bozzani
- Vascular and Endovascular Surgery, Fondazione I.R.C.C.S. Policlinico San Matteo, P.le Golgi 19, 27100 Pavia, ITALY.
| | | | - Franco Ragni
- Vascular and Endovascular Surgery, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, ITALY
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25
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Bozzani A, Arici V, Tavazzi G, Boschini S, Guglielmi A, Mazza G, Mojoli F, Bruno R, Ragni F, Sterpetti AV. A simple prognostic score for COVID-19 hospitalized patients developing deep vein thrombosis. Phlebology 2021; 36:835-840. [PMID: 34212790 DOI: 10.1177/02683555211030099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of our study was to analyze the specificity, accuracy and sensitivity of a simple, easy to calculate, prognostic score for hospitalized COVID19 patients developing deep vein thrombosis. METHODS From March 1st to April 28th, 942 COVID-19 patients with severe symptoms were admitted to the hospital San Matteo of Pavia-Italy. Thirty two patients (3.4%) developed deep vein thrombosis during hospitalization. In all patients hemostatic and inflammatory parameters were abnormal. A simple prognostic score was developed based on the presence of specific co morbidities and D-dimers levels (quick San Matthew Score-quick SMS). RESULTS Nine patients died in a condition of multiple organ failure, 23 patients (71.9%) survived and left the hospital in good general conditions. The developed score was based simply on two parameters: 1) presence of four specific co morbidities and 2)systemic levels of D-Dimers. The quick San Matthew Score resulted in a sensitivity, specificity and overall accuracy of more than 90% (94%, 92%,93% respectively) and compared favorably with other scores. The score was prospectively validated in 100 COVID19 patients who developed deep vein thrombosis collected from the literature and prospectively confirmed in our hospital. CONCLUSIONS The findings of our study underline the importance of an immediate aggressive therapeutic approach for moderate and high-risk patients with COVID19 infection. The quick SMS score may help to identify patients at high risk for mortality and to follow the clinical outcome of the patient. A simple, easy to calculate prognostic score may also facilitate communication among health workers.
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Affiliation(s)
- Antonio Bozzani
- Vascular and Endovascular Surgery Unit, 18631Fondazione IRCCS Policlinico San Matteo, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vittorio Arici
- Vascular and Endovascular Surgery Unit, 18631Fondazione IRCCS Policlinico San Matteo, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Guido Tavazzi
- Anesthesiology and Intensive Care Unit, 18631Fondazione IRCCS Policlinico San Matteo, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Medical, Surgical, Diagnostic and Pediatric Science, 19001University of Pavia, University of Pavia, Pavia, Italy
| | - Stefano Boschini
- Vascular and Endovascular Surgery Unit, 18631Fondazione IRCCS Policlinico San Matteo, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Angelo Guglielmi
- Anesthesiology and Intensive Care Unit, 18631Fondazione IRCCS Policlinico San Matteo, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giovanni Mazza
- Anesthesiology and Intensive Care Unit, 18631Fondazione IRCCS Policlinico San Matteo, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Mojoli
- Anesthesiology and Intensive Care Unit, 18631Fondazione IRCCS Policlinico San Matteo, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Medical, Surgical, Diagnostic and Pediatric Science, 19001University of Pavia, University of Pavia, Pavia, Italy
| | - Raffaele Bruno
- Department of Medical, Surgical, Diagnostic and Pediatric Science, 19001University of Pavia, University of Pavia, Pavia, Italy.,Infectious Diseases Unit, 18631Fondazione IRCCS Policlinico San Matteo, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Franco Ragni
- Vascular and Endovascular Surgery Unit, 18631Fondazione IRCCS Policlinico San Matteo, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Franciscone MM, Danesino V, Arici V, Bozzani A, Ragni F. Re: "Off-Label Use of a Flared Endograft Limb for Treatment of a Complicated Anastomotic Abdominal Aortic Pseudoaneurysm: Reverse Deployment Throught Axillary Artery". Ann Vasc Surg 2021; 75:e4. [PMID: 33901615 DOI: 10.1016/j.avsg.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Mila Maria Franciscone
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vittorio Danesino
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vittorio Arici
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Bozzani
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Franco Ragni
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Bozzani A, Arici V, Tavazzi G, Mojoli F, Bruno R, Sterpetti AV, Ragni F. Acute Thrombosis of Lower Limbs Arteries in the Acute Phase and After Recovery From COVID19. Ann Surg 2021; 273:e159-e160. [PMID: 33417332 PMCID: PMC7959866 DOI: 10.1097/sla.0000000000004700] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Antonio Bozzani
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vittorio Arici
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Guido Tavazzi
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Medical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Italy
| | - Francesco Mojoli
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Medical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Italy
| | - Raffaele Bruno
- Infectious Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Medical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Italy
| | | | - Franco Ragni
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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28
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Bozzani A, Arici V, Ticozzelli G, Boschini S, Franciscone MM, Danesino V, Brunetto MB, Rossi M, Sterpetti AV, Ragni F. The Fate of Open Surgery in the EVAR Era. Ann Vasc Surg 2021; 73:e8-e9. [PMID: 33549773 DOI: 10.1016/j.avsg.2021.01.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Antonio Bozzani
- Vascular and Endovascular Surgery, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
| | - Vittorio Arici
- Vascular and Endovascular Surgery, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Giulia Ticozzelli
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefano Boschini
- Vascular and Endovascular Surgery, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Mila Maria Franciscone
- Vascular and Endovascular Surgery, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Vittorio Danesino
- Vascular and Endovascular Surgery, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Massimo Borri Brunetto
- Vascular and Endovascular Surgery, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Mauro Rossi
- Vascular and Endovascular Surgery, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | | | - Franco Ragni
- Vascular and Endovascular Surgery, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
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29
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Bozzani A, Arici V, Tavazzi G, Boschini S, Mojoli F, Bruno R, Sterpetti AV, Ragni F. Re: "Endothelitis in COVID-19-Positive Patients after Extremity Amputation for Acute Thrombotic Events". Ann Vasc Surg 2021; 73:e6-e7. [PMID: 33548400 PMCID: PMC7857031 DOI: 10.1016/j.avsg.2021.01.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 12/29/2022]
Affiliation(s)
- Antonio Bozzani
- Vascular and Endovascular Surgery, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
| | - Vittorio Arici
- Vascular and Endovascular Surgery, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Guido Tavazzi
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Medical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy
| | - Stefano Boschini
- Vascular and Endovascular Surgery, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Francesco Mojoli
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Medical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy
| | - Raffaele Bruno
- Infectious Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Medical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy
| | | | - Franco Ragni
- Vascular and Endovascular Surgery, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
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30
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Rota M, Arici V, Franciscone MM, Danesino V, Rossini R, Ticozzelli G, Sterpetti AV, D'Ercole L, Ragni F, Bozzani A. Abdominal Aorta Angiosarcoma after Endovascular Aneurysm Repair. Ann Vasc Surg 2021; 73:525-528. [PMID: 33503501 DOI: 10.1016/j.avsg.2020.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/29/2020] [Accepted: 12/05/2020] [Indexed: 11/29/2022]
Abstract
Primary tumors originating within the wall of the arteries are rare and they frequently manifest late, making effective treatment a challenge. We describe here a case of Abdominal Aorta AngioSarcoma masqueraded as an infected EndoVascular Aortic Repair. The knowledge of this pathology from vascular surgeons and radiologist is crucial, because a prompt diagnosis and treatment can improve the prognosis.
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Affiliation(s)
- Monica Rota
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vittorio Arici
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mila Maria Franciscone
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vittorio Danesino
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Rosa Rossini
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulia Ticozzelli
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Loredana D'Ercole
- Department of Medical Physics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Franco Ragni
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Bozzani
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
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31
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Bozzani A, Pallini M, Arici V, Tavazzi G, Ticozzelli G, Franciscone MM, Danesino V, Mojoli F, Ragni F, Sterpetti AV. Re-organization of the Vascular Surgery Department During the Acute Phase of the COVID19 Outbreak: Lessons Learned and Future Perspectives. Ann Vasc Surg 2021; 72:191-195. [PMID: 33333189 PMCID: PMC7832376 DOI: 10.1016/j.avsg.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/01/2020] [Accepted: 12/05/2020] [Indexed: 12/24/2022]
Abstract
Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection represents a serious threat to public health because it leads to a wide spectrum of clinical manifestations. The region Lombardia (Italy) has suffered from severe problems during the acute phase of the outbreak in Italy (March–April 2020). The aim of our analysis is to report the experience of the Department of Vascular Surgery of Pavia, including the learned lessons and future perspectives, considering that the COVID-19 outbreak is in its acute phase in other continents. Material and methods Single-center, retrospective, observational study based on extracted data from the medical records of all consecutive COVID-19 patients observed in our Vascular Department between March 1st and April 30th, 2020. We reviewed the records for demographic information, comorbidities, laboratory tests, and anticoagulation treatment at the time of hospital admission. Results We observed an important reduction in elective and urgent interventions compared to the same period of the previous year; in parallel, we observed an increase in the diagnosis of deep vein thrombosis (DVT) in hospitalized patients, especially with severe infection. In our department, four infections were reported among health workers. Conclusions The impact of the COVID19 pandemic on health-care delivery has been massive. A wave of vascular-related complications is expected. Regular SARS-CoV-2 screening, adequate protection, and quick reorganization of health-care resources are still needed.
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Affiliation(s)
- Antonio Bozzani
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Maura Pallini
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vittorio Arici
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Guido Tavazzi
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Medical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Italy
| | - Giulia Ticozzelli
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mila Maria Franciscone
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vittorio Danesino
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Mojoli
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Franco Ragni
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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32
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Bozzani A, Arici V, Tavazzi G, Franciscone MM, Danesino V, Rota M, Rossini R, Sterpetti AV, Ticozzelli G, Rumi E, Mojoli F, Bruno R, Ragni F. Acute arterial and deep venous thromboembolism in COVID-19 patients: Risk factors and personalized therapy. Surgery 2020; 168:987-992. [PMID: 33039110 PMCID: PMC7508538 DOI: 10.1016/j.surg.2020.09.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/07/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND The Lombardy region suffered severely during the acute phase of the coronavirus disease 2019 outbreak in Italy (Mar-Apr 2020) with 16,000 diagnosed coronavirus disease 2019-related deaths (49% of the total coronavirus disease 2019-related deaths in Italy). In the area surrounding Pavia during the critical stage of the outbreak (Mar-Apr 2020), 1,225 of the documented 4,200 deaths were related to coronavirus disease 2019 infection, with a mortality rate of 181/100,000 inhabitants and an increase in deaths of 138% compared with the same period during previous years. Our aim was to report the experience of the Department of Vascular Surgery of Pavia (Lombardy, Italy), including the lessons learned and future perspectives regarding the management of coronavirus disease 2019 patients who developed severe acute ischemia with impending lower limb loss or deep vein thrombosis. MATERIALS AND METHODS We carried out a retrospective data collection of coronavirus disease 2019 patients with severe acute ischemia of the lower limbs or deep vein thrombosis, which we observed in our department during the period March 1, 2020, to April 30, 2020. Primary outcomes of the analysis were postoperative mortality for all patients and amputation rates only in those coronavirus disease 2019 patients suffering from acute lower limb ischemia. Secondary outcomes were the prevalence of the disease among admitted coronavirus disease 2019 patients, and any possible correlation among inflammatory parameters, thrombolytic status, and the presence of acute ischemia or deep vein thrombosis. RESULTS We observed 38 patients (28 male) with severe coronavirus disease 2019 infection (6 with lower limb arterial thrombosis and 32 with deep vein thrombosis). The median patient age was 64 years (range 30-94 y). In the arterial group, 3 had thrombosis on plaque and 3 on healthy arteries ("simple" arterial thrombosis). All underwent operative or hybrid (open/endo) revascularization; 1 patient died from major organ failure and 1 patient underwent major amputation. In the deep vein thrombosis group, 9 (28%) patients died from major organ failure, despite aggressive medical therapy. In patients with simple arterial thrombosis and those with deep vein thrombosis, we observed a decrease in inflammatory parameters (C-reactive protein) and in D-dimer and fibrinogen after aggressive therapy (P <.001). CONCLUSION Our study confirms that critically ill, coronavirus disease 2019 patients who develop arterial and deep vein thrombosis have a high risk of mortality, but, if treated properly, there is an improvement in overall survival, especially in patients of 60 years of age or younger.
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Affiliation(s)
- Antonio Bozzani
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Vittorio Arici
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Guido Tavazzi
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Medical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Italy
| | - Mila Maria Franciscone
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vittorio Danesino
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Monica Rota
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Rosa Rossini
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Giulia Ticozzelli
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elisa Rumi
- Hematology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Francesco Mojoli
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Medical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Italy
| | - Raffaele Bruno
- Department of Medical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Italy; Infectious Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Franco Ragni
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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33
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Franciscone MM, Danesino V, Bozzani A, Arici V, Ragni F. The Homograft Use in Critical Limb Salvage. Vasc Endovascular Surg 2020; 55:203. [PMID: 33118466 DOI: 10.1177/1538574420966453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Mila Maria Franciscone
- Vascular and Endovascular Surgery, 18631Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Vittorio Danesino
- Vascular and Endovascular Surgery, 18631Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Antonio Bozzani
- Vascular and Endovascular Surgery, 18631Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Vittorio Arici
- Vascular and Endovascular Surgery, 18631Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Franco Ragni
- Vascular and Endovascular Surgery, 18631Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
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34
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Bozzani A, Arici V, Rota M, Ticozzelli G, Ragni F. Case Study of Giant unruptured infrarenal abdominal aortic aneurysms. J Vasc Nurs 2020; 38:191-192. [PMID: 33279109 DOI: 10.1016/j.jvn.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Antonio Bozzani
- Vascular and Endovascular Surgery Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
| | - Vittorio Arici
- Vascular and Endovascular Surgery Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Monica Rota
- Vascular and Endovascular Surgery Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Giulia Ticozzelli
- Anesthesiology and Intensive Care Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Franco Ragni
- Vascular and Endovascular Surgery Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
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35
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Bozzani A, Tavazzi G, Arici V, Sterpetti AV, Rumi E, Mojoli F, Bruno R, Ragni F. Acute deep vein thrombosis in COVID 19 hospitalized patients. Risk factors and clinical outcomes. Phlebology 2020; 36:240-242. [PMID: 32921224 DOI: 10.1177/0268355520958598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Antonio Bozzani
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Guido Tavazzi
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Medical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy
| | - Vittorio Arici
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Elisa Rumi
- Hematology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Francesco Mojoli
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Medical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy
| | - Raffaele Bruno
- Department of Medical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy.,Infectious Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Franco Ragni
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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36
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Rota M, Rossini R, Bozzani A, Franciscone MM, Danesino V, Arici V, Ragni F. Failure of Bronchial Artery Aneurysm Embolization and Use of Thoracic Endoprosthesis. Vasc Endovascular Surg 2020; 55:100. [PMID: 32869727 DOI: 10.1177/1538574420953986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Monica Rota
- Vascular and Endovascular Surgery, 18631Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Rosa Rossini
- Vascular and Endovascular Surgery, 18631Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Antonio Bozzani
- Vascular and Endovascular Surgery, 18631Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Mila Maria Franciscone
- Vascular and Endovascular Surgery, 18631Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Vittorio Danesino
- Vascular and Endovascular Surgery, 18631Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Vittorio Arici
- Vascular and Endovascular Surgery, 18631Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Franco Ragni
- Vascular and Endovascular Surgery, 18631Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
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Bozzani A, Danesino V, Franciscone M. Kommerell's Diverticulum and Early Endovascular Treatment. Ann Thorac Surg 2020; 110:2109-2110. [PMID: 32439391 DOI: 10.1016/j.athoracsur.2020.03.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 03/29/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Antonio Bozzani
- Department of Vascular and Endovascular Surgery, Fondazione IRCCS Policlinico San Matteo, P.le Golgi 19, 27100 Pavia, Italy.
| | - Vittorio Danesino
- Department of Vascular and Endovascular Surgery, Fondazione IRCCS Policlinico San Matteo, P.le Golgi 19, 27100 Pavia, Italy
| | - Mila Franciscone
- Department of Vascular and Endovascular Surgery, Fondazione IRCCS Policlinico San Matteo, P.le Golgi 19, 27100 Pavia, Italy
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Bozzani A, Arici V, Rossi M, Spialtini C, Ragni F. Surgical Excision Is the Gold Standard for a Correct Diagnosis of Carotid Paragangliomas. Ann Vasc Surg 2020; 65:e299-e300. [DOI: 10.1016/j.avsg.2019.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 04/27/2019] [Indexed: 12/01/2022]
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Bozzani A, Arici V, Franciscone MM, Danesino V, Cascina A, Ticozzelli G, Ragni F. Severe Acute Respiratory Syndrome Coronavirus 2 Infection and the Upper Limb Deep Vein Thrombosis Risk. Ann Vasc Surg 2020; 66:11-13. [PMID: 32335249 PMCID: PMC7177144 DOI: 10.1016/j.avsg.2020.04.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 11/23/2022]
Abstract
Little or nothing is known about the correlation between the upper limb deep vein thrombosis (UL-DVT) and severe acute respiratory syndrome coronavirus 2 (SARS–CoV-2). We describe the increased risk of UL-DVT in 3 patients with SARS–CoV-2 who require continuous positive airway pressure with a hood and the need for early adequate antithrombotic prophylaxis.
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Affiliation(s)
- Antonio Bozzani
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Vittorio Arici
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mila Maria Franciscone
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vittorio Danesino
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Giulia Ticozzelli
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Franco Ragni
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Arici V, Bozzani A, Rossi M, Corbetta R, Brunetto MB, Scudeller L, Ticozzelli G, Rossini R, Rota M, Ragni F. Contemporary Early and Long-Term Results of Open Repair for Ruptured and Symptomatic Unruptured Infrarenal AAA. Single Center Experience. Ann Vasc Surg 2020; 64:99-108. [DOI: 10.1016/j.avsg.2019.10.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
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Mauri S, Bozzani A, Ferlini M, Aiello M, Gazzoli F, Pirrelli S, Valsecchi F, Ferrario M. Combined Transcatheter Treatment of Severe Aortic Valve Stenosis and Infrarenal Abdominal Aortic Aneurysm in Increased Surgical Risk Patients. Ann Vasc Surg 2019; 60:480.e1-480.e5. [DOI: 10.1016/j.avsg.2019.03.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 03/21/2019] [Accepted: 03/26/2019] [Indexed: 12/20/2022]
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Bozzani A, Arici V, Ragni F. Potential Role of Blood Testing to Detect Endoleaks After Endovascular Aneurysm Repair. J Endovasc Ther 2019; 26:747-748. [PMID: 31544600 DOI: 10.1177/1526602819865983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Antonio Bozzani
- Vascular Surgery Unit, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Vittorio Arici
- Vascular Surgery Unit, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Franco Ragni
- Vascular Surgery Unit, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
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Rossini R, Tarantini G, Musumeci G, Masiero G, Barbato E, Calabrò P, Capodanno D, Leonardi S, Lettino M, Limbruno U, Menozzi A, Marchese UOA, Saia F, Valgimigli M, Ageno W, Falanga A, Corcione A, Locatelli A, Montorsi M, Piazza D, Stella A, Bozzani A, Parolari A, Carone R, Angiolillo DJ. A Multidisciplinary Approach on the Perioperative Antithrombotic Management of Patients With Coronary Stents Undergoing Surgery: Surgery After Stenting 2. JACC Cardiovasc Interv 2019. [PMID: 29519377 DOI: 10.1016/j.jcin.2017.10.051] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Perioperative management of antithrombotic therapy in patients treated with coronary stents undergoing surgery remains poorly defined. Importantly, surgery represents a common reason for premature treatment discontinuation, which is associated with an increased risk in mortality and major adverse cardiac events. However, maintaining antithrombotic therapy to minimize the incidence of perioperative ischemic complications may increase the risk of bleeding complications. Although guidelines provide some recommendations with respect to the perioperative management of antithrombotic therapy, these have been largely developed according to the thrombotic risk of the patient and a definition of the hemorrhagic risk specific to each surgical procedure, key to defining the trade-off between ischemia and bleeding, is not provided. These observations underscore the need for a multidisciplinary collaboration among cardiologists, anesthesiologists, hematologists and surgeons to reach this goal. The present document is an update on practical recommendations for standardizing management of antithrombotic therapy management in patients treated with coronary stents (Surgery After Stenting 2) in various types of surgery according to the predicted individual risk of thrombotic complications against the anticipated risk of surgical bleeding complications. Cardiologists defined the thrombotic risk using a "combined ischemic risk" approach, while surgeons classified surgeries according to their inherent hemorrhagic risk. Finally, a multidisciplinary agreement on the most appropriate antithrombotic treatment regimen in the perioperative phase was reached for each surgical procedure.
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Affiliation(s)
- Roberta Rossini
- Dipartimento Emergenze e Aree Critiche, Ospedale Santa Croce e Carle, Cuneo, Italy.
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Giuseppe Musumeci
- Dipartimento Emergenze e Aree Critiche, Ospedale Santa Croce e Carle, Cuneo, Italy
| | - Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Emanuele Barbato
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Paolo Calabrò
- Division of Cardiology, Department of Cardio-Thoracic Sciences, Università degli Studi della Campania "Luigi Vanvitelli," Naples, Italy
| | - Davide Capodanno
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele, Catania, Italy; Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Sergio Leonardi
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardiovascular Department, Humanitas Research Hospital, Rozzano, Italy
| | - Ugo Limbruno
- U.O.C. Cardiologia, Azienda USL Toscana Sudest, Grosseto, Italy
| | - Alberto Menozzi
- Unità Operativa di Cardiologia, Azienda Ospedaliero-Universitaria di Parma, Italy
| | - U O Alfredo Marchese
- U.O.C. Cardiologia Interventistica, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Francesco Saia
- Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Marco Valgimigli
- Swiss Cardiovascular Centre Bern, Bern University Hospital, Bern, Switzerland
| | - Walter Ageno
- Degenza Breve Internistica e Centro Trombosi ed Emostasi, Dipartimento di Medicina e Chirurgia, Università dell'Insubria, Varese, Italy
| | - Anna Falanga
- Department of Immunohematology and Transfusion Medicine, Thrombosis and Hemostasis Center, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Antonio Corcione
- Department of Anaesthesia and Critical Care, AORN Dei Colli, Naples, Italy
| | - Alessandro Locatelli
- Dipartimento Emergenze e Aree Critiche, Ospedale Santa Croce e Carle, Cuneo, Italy
| | - Marco Montorsi
- Dipartimento di Chirurgia Generale, Humanitas Research Hospital and University, Milano, Italy
| | - Diego Piazza
- Policlinico Vittorio Emanuele di Catania, Catania, Italy
| | - Andrea Stella
- Chirurgia Vascolare, Università di Bologna, Ospedale Sant'Orsola-Malpighi, Bologna, Italy
| | - Antonio Bozzani
- UOC Chirurgia Vascolare, Dipartimento di Scienze Chirurgiche, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Alessandro Parolari
- Dipartimento di Scienze Biomediche per la Salute, Policlinico San Donato IRCCS, University of Milano, Milan, Italy
| | - Roberto Carone
- Azienda Ospedaliera Universitaria Città della salute e della scienza, Torino, Italy
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida, College of Medicine-Jacksonville, Jacksonville, Florida
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Ucci A, Curci R, Azzarone M, Bianchini Massoni C, Bozzani A, Marcato C, Marone EM, Perini P, Tecchio T, Freyrie A, Argenteri A. Early and mid-term results in the endovascular treatment of popliteal aneurysms with the multilayer flow modulator. Vascular 2018; 26:556-563. [PMID: 29665749 DOI: 10.1177/1708538118771258] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background The endovascular approach became an alternative to open surgical treatment of popliteal artery aneurysm over the last few years. Heparin-bonded stent-grafts have been employed for endovascular popliteal artery aneurysm repair, showing good and stable results. Only few reports about the use of multilayer flow modulator are available in literature, providing small patient series and short follow-up. The aim of this study is to report the outcomes of patients with popliteal artery aneurysm treated with the multilayer flow modulator in three Italian centres. Methods We retrospectively analysed a series of both symptomatic and asymptomatic patients with popliteal artery aneurysm treated with the multilayer flow modulator from 2009 to 2015. Follow-up was undertaken with clinical and contrast-enhanced ultrasound examinations at 1, 6 and 12 months, and yearly thereafter. Computed tomography angiography was performed in selected cases. Primary endpoints were aneurysm sac thrombosis; freedom from sac enlargement and primary, primary-assisted and secondary patency during follow-up. Secondary endpoints were technical success, collateral vessels patency, limb salvage and aneurysm-related complications. Results Twenty-three consecutive patients (19 males, age 72 ± 11) with 25 popliteal artery aneurysms (mean diameter 23 mm ± 1, 3 symptomatic patients) were treated with 40 multilayer flow modulators during the period of the study. Median follow-up was 22.6 ± 16.7 months. Complete aneurysm thrombosis occurred in 92.9% of cases (23/25 cases) at 18 months. Freedom from sac enlargement was 100% (25/25 cases) with 17 cases of aneurysm sac shrinkage (68%). At 1, 6, 12 and 24 months, estimated primary patency was 95.7%, 87.3%, 77% and 70.1%, respectively. At the same intervals, primary-assisted patency was 95.7%, 91.3%, 86% and 86%, respectively, and secondary patency was 100%, 95.7%, 90.3% and 90.3%, respectively. Technical success was 100%. The collateral vessels patency was 72.4%. Limb salvage was 91.4% at 24-month follow-up. One multilayer flow modulator fracture was reported in an asymptomatic patient. Conclusions Multilayer flow modulator seems a feasible and safe solution for endovascular treatment of popliteal artery aneurysms in selected patients.
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Affiliation(s)
- Alessandro Ucci
- 1 Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy
| | - Ruggiero Curci
- 2 Unit of Vascular and Endovascular Surgery, ASST Lodi, Maggiore Hospital, Lodi, Italy
| | - Matteo Azzarone
- 1 Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy
| | - Claudio Bianchini Massoni
- 1 Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy
| | - Antonio Bozzani
- 3 Unit of Vascular Surgery, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Carla Marcato
- 4 Department of Diagnostic and Interventional Radiology, University of Parma, Maggiore Hospital, Parma, Italy
| | - Enrico Maria Marone
- 3 Unit of Vascular Surgery, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Paolo Perini
- 1 Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy
| | - Tiziano Tecchio
- 1 Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy
| | - Antonio Freyrie
- 1 Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy
| | - Angelo Argenteri
- 3 Unit of Vascular Surgery, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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Bozzani A, Arici V, Rodolico G, Brunetto MB, Argenteri A. Endovascular Exclusion of Aortobronchial Fistula and Distal Anastomotic Aneurysm after Extra-Anatomic Bypass for Aortic Coarctation. Tex Heart Inst J 2017; 44:55-57. [PMID: 28265214 DOI: 10.14503/thij-15-5542] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The treatment of choice for aortic coarctation in adults remains open surgical repair. Aortobronchial fistula is a rare but potentially fatal late sequela of surgical correction of isthmic aortic coarctation via the interposition of a graft. The endovascular treatment of aortobronchial fistula is still under discussion because of its high risk for infection, especially if the patient has a history of cardiovascular prosthetic implantation. Patients need close monitoring, most notably those with secondary aortobronchial fistula. We discuss the case of a 65-year-old man who presented with the combined conditions, and we briefly review the relevant medical literature.
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Arici V, Perotti C, Fabrizio C, Del Fante C, Ragni F, Alessandrino F, Viarengo G, Pagani M, Moia A, Tinelli C, Bozzani A. Autologous immuno magnetically selected CD133+ stem cells in the treatment of no-option critical limb ischemia: clinical and contrast enhanced ultrasound assessed results in eight patients. J Transl Med 2015; 13:342. [PMID: 26526721 PMCID: PMC4630831 DOI: 10.1186/s12967-015-0697-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 10/14/2015] [Indexed: 01/10/2023] Open
Abstract
Objectives Demonstrate the safety and effectiveness of highly purified CD133+ autologous stem cells in critical limb ischemia (CLI). Design Prospective single-center not randomized. Clinicaltrials.gov identifier: NCT01595776 Methods Eight patients with a history of stable CLI were enrolled in a period of 2 years. After bone marrow stimulation and single leukapheresis collection, CD133+ immunomagnetic cell selection was performed. CD133+ cells in buffer phosphate suspension was administered intramuscularly. Muscular and arterial contrast enhanced ultra sound (CEUS), lesion evolution and pain management were assessed preoperatively and 3, 6 and 12 months after the implant. Results No patient had early or late complications related to the procedure. Two patients (25 %) didn’t get any relief from the treatment and underwent major amputation. Six patients (75 %) had a complete healing of the wounds, rest pain cessation and walking recovery. An increase in CEUS values was shown in all eight patients at 6 months and in the six clinical healed patients at 12 months and had statistical relevance. Conclusions Highly purified autologous CD133+ cells can stimulate neo-angiogenesis, as based on clinical and CEUS data. Electronic supplementary material The online version of this article (doi:10.1186/s12967-015-0697-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vittorio Arici
- Vascular Surgery Unit, Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Piazzale Golgi 19, 27100, Pavia, Italy.
| | - Cesare Perotti
- Haemotransfusional Service, Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia, Italy.
| | - Calliada Fabrizio
- Radiology Service, Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia, Italy.
| | - Claudia Del Fante
- Haemotransfusional Service, Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia, Italy.
| | - Franco Ragni
- Vascular Surgery Unit, Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Piazzale Golgi 19, 27100, Pavia, Italy.
| | - Francesco Alessandrino
- Radiology Service, Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia, Italy.
| | - Gianluca Viarengo
- Haemotransfusional Service, Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia, Italy.
| | - Michele Pagani
- Anesthesiology and Intensive Care Unit 2, Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia, Italy.
| | - Alessia Moia
- Vascular Surgery Unit, Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Piazzale Golgi 19, 27100, Pavia, Italy.
| | - Carmine Tinelli
- Statistics and Epidemiology Service, Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia, Italy.
| | - Antonio Bozzani
- Vascular Surgery Unit, Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Piazzale Golgi 19, 27100, Pavia, Italy.
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Bozzani A, Ferlini M, Rossini R, Musumeci G, Arici V, Bramucci E, Setacci C. Antiplatelet therapy management in patients with coronary stent undergoing vascular surgery. J Cardiovasc Surg (Torino) 2015; 56:681-683. [PMID: 25008060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- A Bozzani
- Division of Vascular Surgery, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy -
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Bozzani A, Arici V, Bonalumi G, Argenteri A. Descending Thoracic Aorta Remodeling after Multilayer Stent Release. Ann Vasc Surg 2015; 29:1018.e9-1018.e11. [DOI: 10.1016/j.avsg.2015.01.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/01/2015] [Accepted: 01/05/2015] [Indexed: 11/27/2022]
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Bozzani A, Arici V, Ragni F, Argenteri A. Endoleak after endovascular aortic repair and lumbar vertebral erosion. J Orthop Traumatol 2014; 16:75. [PMID: 25468593 PMCID: PMC4348494 DOI: 10.1007/s10195-014-0329-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 11/08/2014] [Indexed: 11/28/2022] Open
Affiliation(s)
- Antonio Bozzani
- Vascular and Endovascular Surgery, Foundation I.R.C.C.S. Policlinico San Matteo, P.le Golgi 19, 27100, Pavia, Italy,
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Bozzani A, Arici V, Ragni F. Letter on the article "Malignant head/neck paragangliomas. Comparative study". Eur Ann Otorhinolaryngol Head Neck Dis 2014; 132:109. [PMID: 25456240 DOI: 10.1016/j.anorl.2013.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 12/23/2013] [Indexed: 11/24/2022]
Affiliation(s)
- A Bozzani
- Vascular Surgery, Foundation I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100 Pavia, Italy.
| | - V Arici
- Vascular Surgery, Foundation I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100 Pavia, Italy
| | - F Ragni
- Vascular Surgery, Foundation I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100 Pavia, Italy
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