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Gabriele R, Campagnol M, Iannone I, Borrelli V, Sterpetti AV. Education and information to improve rates for attendance to colorectal cancer screening programs. Surg Open Sci 2024; 19:105-107. [PMID: 38617096 PMCID: PMC11015520 DOI: 10.1016/j.sopen.2024.03.017] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/25/2024] [Indexed: 04/16/2024] Open
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Sterpetti AV, Gabriele R, Di Marzo L. Sex disparities for clinical outcomes after percutaneous coronary intervention for acute coronary syndrome. Int J Cardiol 2024; 404:131937. [PMID: 38437951 DOI: 10.1016/j.ijcard.2024.131937] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/01/2024] [Indexed: 03/06/2024]
Affiliation(s)
- Antonio V Sterpetti
- Department of Surgery and Vascular-Endovascular Surgery Sapienza University Rome, Italy.
| | - Raimondo Gabriele
- Department of Surgery and Vascular-Endovascular Surgery Sapienza University Rome, Italy
| | - Luca Di Marzo
- Department of Surgery and Vascular-Endovascular Surgery Sapienza University Rome, Italy
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Sterpetti AV, Gabriele R, Iannone I, Dimarzo L, Borrelli V. National organized screening programs for breast, colorectal, and cervical cancer reduce socioeconomic disparities, but it is not enough. Cancer 2024. [PMID: 38642368 DOI: 10.1002/cncr.35335] [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: 04/22/2024]
Affiliation(s)
| | | | | | - Luca Dimarzo
- Department of Surgery, Sapienza University of Rome, Rome, Italy
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Sterpetti AV, Gabriele R, Dimarzo L. Asymptomatic Carotid Stenosis. Ann Vasc Surg 2024; 104:255-257. [PMID: 38599482 DOI: 10.1016/j.avsg.2024.02.019] [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: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 04/12/2024]
Affiliation(s)
| | | | - Luca Dimarzo
- Department of Vascular Surgery, Sapienza University; Rome, Italy
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Sterpetti AV, Gabriele R, Iannone I, Campagnol M, Borrelli V, Sapienza P, Dimarzo L. Trends towards increase of Cardiovascular diseases mortality in USA: A comparison with Europe and the importance of preventive care. Curr Probl Cardiol 2024; 49:102459. [PMID: 38346607 DOI: 10.1016/j.cpcardiol.2024.102459] [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: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND the aim of our study was to analyze exposure of the general population to established risk factors for cardiovascular disease (CVD), which might have determined the trend towards increased mortality rates related with CVD from 2015 to 2019 in USA. MATERIAL AND METHODS We Analyzed epidemiological of data from the US National Health and Nutrition Examination Survey and from the European Health Interview Survey to determine trends for exposure to several established risk factors for CVD from 2000 to 2018-2019. Trends of prevalence of obesity, arterial hypertension, cigarettes smoking, high cholesterol level, diabetes in the period 2000 to 2018-2019 in USA were correlated with age adjusted mortality and burden related with CVD. We correlated these trends also with educational attainment, family income and national expenditure for preventive care. RESULTS Cardiovascular Diseases Related Mortality And Burden Decreased Significantly In Usa In The Period 2000-2015; In The Period 2015-2019 there was a trend towards increasing mortality rates. The trend in the period 2015-2019 was associated with increased exposure to several established risk factors for CVD: obesity, diabetes, cigarettes smoking and arterial hypertension. Level of education attainment and family income, and national health expenditure for information, education and counseling were statistically correlated with reduced exposure to established risk factors. Similar trends were present in Western European countries. CONCLUSIONS Attention is required to improve education and communication, health access and care for people with poor economic conditions, homeless, minorities, to reduce CVD related mortality and burden.
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Affiliation(s)
| | | | | | | | | | | | - Luca Dimarzo
- Department Of Vascular Surgery, Sapienza University Rome Italy
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Sterpetti AV, Di Marzo L, Sapienza P, Gabriele R, Borrelli V. Reduced carotid revascularization and screening for asymptomatc patients during the COVID-19 pandemic in Italy. J Vasc Surg 2024; 79:988-990. [PMID: 38519224 DOI: 10.1016/j.jvs.2023.12.007] [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: 12/05/2023] [Revised: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 03/24/2024]
Affiliation(s)
| | - Luca Di Marzo
- Department of Surgery, Sapienza University, Rome, Italy
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Sterpetti AV, Gabriele R, Borrelli V, Campagnol M, Iannone I, Costi U, Sapienza P, Dimarzo L. Clinical outcomes for patients with cardiovascular diseases before, during, and after the COVID19 pandemic. A pooled analysis of 600.000 patients. Curr Probl Cardiol 2024; 49:102540. [PMID: 38521287 DOI: 10.1016/j.cpcardiol.2024.102540] [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: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND The unexpected virulence of the COVID19 pandemic brought to significant changes of generally accepted therapeutic approaches. The consequences of these changes were difficult to define during the pandemic period. METHODS We analyzed the National Registries including 97% of hospital admissions in Italy, regarding data describing number of operations for aortic valve implantation or repair, carotid and coronary revascularization, AAA repair, and lower limb arterial reconstruction performed in the period 2015 to 2019 and in the pandemic years 2020, 2021, and 2022. Primary outcomes were number and type of surgical procedures, 30-days operative mortality. RESULTS During the three years of the pandemic there was a statistically significant increase of the number of all-causes deaths in comparison with the mean of the previous five years (2015-2019). In Italy there was a total increase of all causes-deaths of 251.911 (+105900 in 2020; +66929 in 2021; and +79082 in 2022), and 73% of the excess of deaths was related with COVID19 infection and 27% occurred in COVID 19 negative patients. During the first year of the pandemic, worse clinical outcomes for hospitalized patients with CVD were registered. The medical system responded adequately and in the following two pandemic years clinical outcomes for hospitalized patients were similar with those of the pre-pandemic period. CONCLUSIONS The unexpected virulence of COVID19 pandemic determined worse clinical outcomes for patients with CVD during the first year. The adopted preventive measures allowed in the following two pandemic years improved clinical outcomes, similar with those of the pre-pandemic period.
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Affiliation(s)
| | | | | | | | | | | | | | - Luca Dimarzo
- Department of vascular endovascular surgery, Sapienza university Rome, Italy
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Sterpetti AV, Gabriele R, Iannone I, DiMarzo L. Lower exposure to risk factors for stroke in green spaces in comparison with metropolitan areas. The importance of education and information to reduce the difference. J Neurol Sci 2024; 458:122933. [PMID: 38368179 DOI: 10.1016/j.jns.2024.122933] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024]
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Sterpetti AV, Gabriele R, Iannone I, Sapienza P, D'Ermo G, Dimarzo L, Borrelli V. Reduced adherence to cervical cancer screening. The importance of information and education for women with low education and low-income. Int J Cancer 2024. [PMID: 38446981 DOI: 10.1002/ijc.34907] [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: 02/19/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Affiliation(s)
| | | | | | - Paolo Sapienza
- Department of Surgery, University of Rome Sapienza, Rome, Italy
| | - Giuseppe D'Ermo
- Department of Surgery, University of Rome Sapienza, Rome, Italy
| | - Luca Dimarzo
- Department of Surgery, University of Rome Sapienza, Rome, Italy
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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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Sterpetti AV, Di Marzo L. Education and Information to Improve Cardiovascular Health. JAMA Cardiol 2024; 9:305-306. [PMID: 38265766 DOI: 10.1001/jamacardio.2023.5251] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
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Gabriele R, Iannone I, Sapienza P, DI Marzo L, Sterpetti AV. Reduced levels of atmospheric levels of PM 2.5 and simultaneous decrease of hospital admissions for cardiovascular emergencies in Italy. Int J Cardiol Cardiovasc Risk Prev 2024; 20:200241. [PMID: 38357686 PMCID: PMC10865014 DOI: 10.1016/j.ijcrp.2024.200241] [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] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 01/31/2024] [Indexed: 02/16/2024]
Affiliation(s)
| | | | | | - Luca DI Marzo
- Department of Vascular Endovascular Surgery, University of Rome Sapienza Rome Italy
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Sterpetti AV, Gabriele R, Iannone I, Sapienza P, Marzo LD. The role of education and information to prevent trends towards increase of cardiovascular mortality rates in Europe from 2015 TO 2019. Curr Probl Cardiol 2024; 49:102415. [PMID: 38253115 DOI: 10.1016/j.cpcardiol.2024.102415] [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: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND In Europe Cardio Vascular Disease (CVD) mortality rates decreased significantly in the last 25 years, with less decline in the last 5 years. The aim of our study was to analyze trends of risk factors which may explain plateauing of CVD mortality rates in the period 2015-2019 in Europe. METHODS We analyzed data from the Global Burden Disease and EUROSTAT concerning trends of CVD mortality rates for 25 European countries and simultaneous changes of exposure to risk factors of the population RESULTS: CVD related mortality decreased significantly in the analyzed countries in the period 2000-2015; in the period 2015-2019 there was a trend towards plateauing of CVD related mortality rates, which was associated with an increased exposure to several established risk factors including cigarette smoking, obesity and arterial hypertension. A decrease in expenditure for information, education and counseling programs was documented in most countries in the same period. Level of exposure to risk factors was correlated with educational attainment . Exposure to risk factors in the interval 2014-2019 increased for people with lower education, whereas decreased in people with higher education (p<0.001). CONCLUSIONS Organized information about risk factors for CVD have the potential to reduce mortality and burden, with diminished total health expenses. Education and information in this setting should consider the cultural and social level of the public.
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Affiliation(s)
- Antonio V Sterpetti
- Department of Surgery, Sapienza University, Policlinico Umberto I, Viale del Policlinico 00167, Rome, Italy.
| | - Raimondo Gabriele
- Department of Surgery, Sapienza University, Policlinico Umberto I, Viale del Policlinico 00167, Rome, Italy
| | - Immacolata Iannone
- Department of Surgery, Sapienza University, Policlinico Umberto I, Viale del Policlinico 00167, Rome, Italy
| | - Paolo Sapienza
- Department of Surgery, Sapienza University, Policlinico Umberto I, Viale del Policlinico 00167, Rome, Italy
| | - Luca Di Marzo
- Department of Vascular Surgery, Sapienza University, Rome, Italy
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Sterpetti AV, Gabriele R, Sapienza P, Marzo LD, Borrelli V. Mortality and burden related with aortic aneurysms and dissections. The importance of information and education. Curr Probl Cardiol 2024; 49:102384. [PMID: 38184128 DOI: 10.1016/j.cpcardiol.2024.102384] [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: 12/27/2023] [Accepted: 01/04/2024] [Indexed: 01/08/2024]
Abstract
BACKGROUND In this study we correlated changes of risk factors for cardiovascular diseases with trends of age standardized mortality rates and burden for aortic aneurysms and dissections. METHODS We analyzed data from the Global Burden of Diseases and EUROSTAT. FINDINGS There was a significant increase of expenditure for health from 1980 and 2019. In the period 1980-2000, despite higher health spending, age standardized mortality rates increased in almost all European countries. During the period 2000-2019, in Western European Countries and in Poland, Estonia, Latvia, Slovenia there was a correlation between higher health expenditure and decrease of ASMR. The most important changes between the period 1980-2000 and the period 2000-2019 was the proportion of health expenditure devoted to preventive care and to the increased use of aspirin and statins. INTERPRETATION Information about risk factors for cardiovascular diseases have leads to decreased aortic aneurysm related mortality and burden.
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Affiliation(s)
- Antonio V Sterpetti
- Sapienza University Rome, Policlinico Umberto I- Viale del Policlinico 00167 Rome, Italy.
| | - Raimondo Gabriele
- Sapienza University Rome, Policlinico Umberto I- Viale del Policlinico 00167 Rome, Italy
| | - Paolo Sapienza
- Sapienza University Rome, Policlinico Umberto I- Viale del Policlinico 00167 Rome, Italy
| | - Luca Di Marzo
- Sapienza University Rome, Policlinico Umberto I- Viale del Policlinico 00167 Rome, Italy
| | - Valeria Borrelli
- Sapienza University Rome, Policlinico Umberto I- Viale del Policlinico 00167 Rome, Italy
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Fiori E, Lamazza A, Crocetti D, Sterpetti AV. Editorial article to: Animal experimental study on magnetic anchor technique-assisted endoscopic submucosal dissection of early gastric cancer. World J Gastrointest Endosc 2024; 16:51-54. [PMID: 38464819 PMCID: PMC10921155 DOI: 10.4253/wjge.v16.i2.51] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/07/2023] [Accepted: 01/11/2024] [Indexed: 01/31/2024] Open
Abstract
In this editorial we comment on the article published in the recent issue of the World Journal of Gastrointestinal Endoscopy 2023; 15 (11): 634-680. Gastric cancer (GC) remains the fifth most common malignancy and the fourth leading cause of cancer-related death worldwide. The overall prevalence of GC has declined, although that of proximal GC has increased over time. Thus, a significant proportion of GC cases and deaths can be avoided if preventive interventions are taken. Early GC (EGC) is defined as GC confined to the mucosa or submucosa. Endoscopic resection is considered the most appropriate treatment for precancerous gastrointestinal lesions improving patient quality of life, with reduced rates of complications, shorter hospitalization period, and lower costs when compared to surgical resection. Endoscopic mucosal resection (EMR) and endoscopic sub-mucosal dissection (ESD) are representative endoscopic treatments for EGC and precancerous gastric lesions. Standard EMR implies injection of a saline solution into the sub-mucosal space, followed by excision of the lesion using a snare. Complete resection rates vary depending on the size and severity of the lesion. When using conventional EMR methods for lesions less than 1 cm in size, the complete resection rate is approximately 60%, whereas for lesions larger than 2 cm, the complete resection rate is low (20%-30%). ESD can be used to remove tumors exceeding 2 cm in diameter and lesions associated with ulcers or submucosal fibrosis. Compared with EMR, ESD has higher en bloc resection rates (90.2% vs 51.7%), higher complete resection rates (82.1 vs 42.2%), and lower recurrence rates (0.65% vs 6.05%). Thus, innovative techniques have been introduced.
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Affiliation(s)
- Enrico Fiori
- Department of Surgery, Sapienza University of Rome, Rome 00161, Italy
| | - Antonietta Lamazza
- Department of Surgery, University of Rome La Sapienza, Rome 00161, Italy
| | - Daniele Crocetti
- Department of Surgery, Sapienza University of Rome, Rome 00161, Italy
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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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Fughelli P, Sterpetti AV. Progress in the Study of Cardiovascular Physiology During the Italian Renaissance. Curr Probl Cardiol 2024; 49:102045. [PMID: 37634672 DOI: 10.1016/j.cpcardiol.2023.102045] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 08/29/2023]
Abstract
This short report underlines the importance of collaboration and communication among scientists. The ideals of progress in medicine and in the care of suffering people have represented continuous stimuli allowing to overcome prejudices, religious and political differences. The modern concepts of blood circulation have been established through a close collaboration and exchanges of ideas among scientists coming from different countries, different religious and political backgrounds. In those days Europe was theater of continuous wars based on political and religious contrasts. There were continuous outbreaks of Plague in several countries. Religious contrasts occurred inside the Christianity and between the Christianity and Islam; contrasts which were based on theological disputes associated with economic and expansionist ambitions, resulting in extreme and rigid religious orthodoxy. Despite these difficulties, medical scientists collaborated overcoming the close boundaries of everyday general confrontations. The ambition for advancement in science and for progress with the potential consequent common good inspired a general sense of community and drove to overcome the boundaries based on contrasts. Science, scientific thinking, dedication to research and to improve knowledge represented yesterday and continue to represent today the common ambition to break down cultural, religious and economic walls. The generosity of science is superior to the superstition of contrasts and arrogance. A message we can bring from the past back to the future and back to today.
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Sterpetti AV, Sapienza P, Borrelli V. Expenses related with a well organized information about risk factors for stroke reduce mortality and burden, with diminished total health expenses. J Stroke Cerebrovasc Dis 2023; 32:107397. [PMID: 37783581 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107397] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/04/2023] Open
Affiliation(s)
- Antonio V Sterpetti
- Surgery, Sapienza University, Policlinico Umberto I, Viale del Policlinico, Rome 00167, Italy.
| | - Paolo Sapienza
- Surgery, Sapienza University, Policlinico Umberto I, Viale del Policlinico, Rome 00167, Italy
| | - Valeria Borrelli
- Surgery, Sapienza University, Policlinico Umberto I, Viale del Policlinico, Rome 00167, 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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25
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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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Brozzetti S, Carati M, Sterpetti AV. SYSTEMATIC REVIEW AND METANALYSIS OF CLINICAL OUTCOMES AFTER ENUCLEATION OF PANCREATIC METASTASES FROM RENAL CELL CARCINOMA. Dig Surg 2023:000528823. [PMID: 36809760 DOI: 10.1159/000528823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 12/20/2022] [Indexed: 02/24/2023]
Abstract
INTRODUCTION A systematic review of the literature was carried out to determine the clinical and oncological outcome of patients who had enucleation of solitary pancreatic metastases from renal cell carcinoma. METHODS Operative mortality, postoperative complications, observed survival and disease free survival were analyzed. The clinical outcomes of patients who had enucleation were compared to those of 857 patients collected from the literature who had standard or atypical pancreatic resection for the same disease using propensity score matching Results: There was no postoperative mortality in the 56 patients who had enucleation of pancreatic metastases from renal cell carcinoma . In 51 patients postoperative complications could be analyzed. Ten patients (10/51=19.6%) had postoperative complications. Three patients (3/51 = 5.9%) had major complications (Clavien-Dindo III or more). Five year observed survival rates and disease free survival for patients with enucleation were 92% and 79% respectively. These results compared favourably with those obtained in patients who had standard resection and other forms of atypical resection (also using propensity score matching). Patients who had partial pancreatic resection (atypical or not) with pancreatic-jejunal anastomosis had increased rates of postoperative complications and local recurrences. CONCLUSIONS Enucleation of pancreatic metastases offers a valid solution in selected patients.
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Lamazza A, Fiori E, Carati M, Antoniozzi A, Pronio A, Sterpetti AV. Endoscopic stenting for left-sided obstructing colorectal cancer. Br J Surg 2022; 109:1333-1334. [PMID: 36164932 DOI: 10.1093/bjs/znac330] [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: 09/04/2022] [Accepted: 09/05/2022] [Indexed: 12/31/2022]
Affiliation(s)
| | - Enrico Fiori
- Department of Surgery, Sapienza University of Rome, Rome, Italy
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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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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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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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Lamazza A, Carati MV, Pronio AM, Fiori E, Antoniozzi A, Sterpetti AV. Positive aspects of self-expandable metallic stent endoscopic placement for malignant colorectal obstruction during the COVID-19 pandemic. Surgery 2022; 173:557-558. [PMID: 35970608 PMCID: PMC9279301 DOI: 10.1016/j.surg.2022.06.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 02/01/2023]
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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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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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35
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Sterpetti AV. Comment on: Ultrasound screening for abdominal aortic aneurysm in high-risk women. Br J Surg 2021; 109:e50. [PMID: 34910121 DOI: 10.1093/bjs/znab435] [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: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 11/14/2022]
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36
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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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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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Lamazza A, Fiori E, Carati MV, Pronio AM, Antoniozzi A, Sterpetti AV. Self-Expandable Metal Stents for Refractory Complete Rectal Obstruction in Patients With Crohn Disease. Inflamm Bowel Dis 2021; 27:e136-e137. [PMID: 34109971 DOI: 10.1093/ibd/izab137] [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] [Indexed: 01/29/2023]
Affiliation(s)
| | - Enrico Fiori
- Department of Surgery, University of Rome Sapienza, Rome, Italy
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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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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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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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Fiori E, Crocetti D, Sapienza P, Miccini M, Cirocchi R, Sterpetti AV, DE Felice F, Costi S, Brachini G, Mingoli A, Lamazza A, DE Toma G. Colon or Rectal Stent Positioning for Advanced Cancer Influences Quality of Life: A Critical Point of View. Anticancer Res 2021; 41:1945-1950. [PMID: 33813400 DOI: 10.21873/anticanres.14961] [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: 02/05/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Endoluminal self-expanding metallic stents (SEMS) may overcome the risk of mortality and morbidity of acute intestinal obstruction because of stage IV colon (CC) or rectal (RC) cancer. We evaluated the QoL in these groups of patients. PATIENTS AND METHODS Forty-eight patients were enrolled in a prospective longitudinal cohort single-center trial to undergo SEMS positioning. Twenty-five patients had a CC and 23 RC. Karnofsky performance scale, Visual Analogue Scale and the EQ-5D- 5L™ questionnaire were administered before treatment and at 1, 3 and 6 months. RESULTS Harmonized to the Italian population, the index values showed a statistically significant deterioration of the QoL in patients with RC when compared to those with CC at 1-, 3- and 6-months (1 month: p=0.001; 3- month: p=0.001; 6-month: p=0.045). Similarly, Visual Analogue Scale showed variations at 1- (p=0.008), 3- (p=0.001) and 6-months (p=0.020). Rectal stent deployment was the only independent predictor for a worse QoL in all domains (p<0.017; OR=0.196; 95%CI=0.51-0.749). CONCLUSION Patients affected with stage IV CC had a better QoL after SEMS placement when compared to those affected with RC. The persistency of the primary tumor at the rectal level, even if irradiated, might negatively affect QoL.
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Affiliation(s)
- Enrico Fiori
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Daniele Crocetti
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy;
| | - Paolo Sapienza
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Michelangelo Miccini
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Roberto Cirocchi
- Department of Surgical and Biomedical Sciences, Perugia University, Terni, Italy
| | - Antonio V Sterpetti
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Francesca DE Felice
- Department of Radiology, Radiotherapy, Oncology and Pathology, "Sapienza" University of Rome, Rome, Italy
| | - Silvano Costi
- Department of Economics and Finance, LUISS Guido Carli, Rome, Italy
| | - Gioia Brachini
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Andrea Mingoli
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Antonietta Lamazza
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Giorgio DE Toma
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, 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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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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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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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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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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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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