1
|
Ucci A, de Troia A, D'Ospina RM, Pedrazzi G, Nabulsi B, Azzarone M, Perini P, Massoni CB, Rossi G, Freyrie A. Carotid endarterectomy in asymptomatic octogenarians: Outcomes at 30 days and 5 years. Vascular 2023; 31:98-106. [PMID: 34923864 DOI: 10.1177/17085381211056434] [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: 11/15/2022]
Abstract
BACKGROUND The following study investigated the 30-day and 5-year relative survival rate and freedom from neurological events in asymptomatic carotid stenosis (ACS) octogenarians who had undergone elective carotid endarterectomy (CEA). METHODS Between January 2008 and June 2014, a retrospective review was conducted on ACS patients who had undergone elective CEA. The patients' sample was divided into two groups: Group A (GA) included octogenarians and Group B (GB) included younger patients. The GA patients were subjected to a risk-scoring system and follow-up. The two groups were compared analysing the following primary endpoints: 30-day mortality, stroke, stroke/death and acute myocardial infarction (AMI); GA patients' survival rate and freedom from neurological events at 5 years. The 30-day secondary endpoints included carotid shunting, redo surgical, need for general anaesthesia with preserved consciousness (GAPC) conversion and length of hospital stay. RESULTS We identified 620 patients with ACS, of them 144 (23.2%) belonged to the GA and 476 (76.8%) belonged to the GB. No statistical difference between the two groups was found regarding the primary and secondary endpoints. One hundred nineteen of 144 GA patients (82.6%) underwent the follow-up; the median follow-up was 78.3 months. The GA patients' 5-year survival rate was 62%, while freedom from cerebral events was 94.9%. Analysis regarding GA patients' 5-year survival rate revealed a significantly lower percentage among the patients with a severe risk score compared with those with a moderate risk score (respectively, 29.5% vs 67.7%; p = .005). The multivariate analysis showed that chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD) were independently associated with lower survival. CONCLUSIONS The 30-day outcomes of CEA in octogenarians are comparable to those in younger patients. Comprehensive life expectancy and preoperative score, rather than age alone, should be taken into account before performing CEA on octogenarian patients, considering the short- and long-term efficacy in stroke prevention.
Collapse
Affiliation(s)
- Alessandro Ucci
- Department of Medicine and Surgery, 9370University of Parma, Parma, Italy
| | - Alessandro de Troia
- Department of Medicine and Surgery, 9370University of Parma, Parma, Italy.,Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
| | | | - Giuseppe Pedrazzi
- Department of Medicine and Surgery, 9370University of Parma, Parma, Italy
| | - Bilal Nabulsi
- Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
| | - Matteo Azzarone
- Department of Medicine and Surgery, 9370University of Parma, Parma, Italy.,Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
| | - Paolo Perini
- Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
| | - Claudio Bianchini Massoni
- Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
| | - Giulia Rossi
- Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
| | - Antonio Freyrie
- Department of Medicine and Surgery, 9370University of Parma, Parma, Italy.,Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
| |
Collapse
|
2
|
Bianchini Massoni C, Perini P, Fanelli M, Ucci A, Azzarone M, Rossi G, D'Ospina RM, Freyrie A. The Utility of Intraoperative Contrast-enhanced Ultrasound for Immediate Treatment of Type Ia Endoleak during EVAR: Initial Experience. Acta Biomed 2021; 92:e2021046. [PMID: 33988179 PMCID: PMC8182572 DOI: 10.23750/abm.v92i2.9154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/15/2020] [Indexed: 12/02/2022]
Abstract
Objectives: Type Ia endoleak (EL) after endovascular abdominal aortic repair (EVAR) may be misdiagnosed at completion angiography. Intraoperative contrast-enhanced ultrasound (CEUS) may play a role in early detection and immediate treatment of type Ia EL. Methods: From January 2017 to April 2018, patients treated with EVAR underwent intraoperative CEUS. After endograft deployment and ballooning, digital subtraction angiography (DSA) and intraoperative CEUS were performed in a blinded fashion. All cases of type Ia EL at DSA or CEUS were considered. Results: Type Ia EL detected at intraoperative CEUS and undetected at DSA was defined in 2 patients. The former was solved with intraoperative re-ballooning; in the latter case, a Palmaz stent deployment was required. The resolution of type Ia EL was detected at intraoperative CEUS control and post-operative computed tomography angiography (CTA). In another patient, the DSA detected a type Ia EL, but intraoperative CEUS reveal a type II EL from lumbar arteries. Post-operative CTA confirm the type II EL. Conclusions: The reported cases prove the clinical utility of the intraoperative CEUS, permitting the early identification of 2 type Ia EL. In addition, the intraoperative CEUS is useful in case of dubious type Ia EL at DSA, avoiding unnecessary intraoperative adjunctive procedure or post-operative CTA. (www.actabiomedica.it)
Collapse
|
3
|
Mariani E, Andreone A, Perini P, Azzarone M, Ucci A, Freyrie A. Endovascular Treatment of Persistent Sciatic Artery Occlusion: Case Report and Literature Review. Ann Vasc Surg 2021; 74:526.e13-526.e23. [PMID: 33838235 DOI: 10.1016/j.avsg.2021.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/26/2021] [Revised: 03/03/2021] [Accepted: 03/07/2021] [Indexed: 11/29/2022]
Abstract
Persistent sciatic artery (PSA) is a rare congenital anatomic variant of the lower limb vascular system with highly variable presentations. The management of lower limb ischemia due to PSA disease is not specifically recommended in guidelines, and surgical by-pass is usually the most described treatment. We reported a case of a 46-year-old patient with bilateral PSA and right chronic limb-threatening ischemia due to PSA occlusion at the PSA-popliteal junction which was successfully treated with percutaneous transluminal balloon angioplasty. In addition to this case report, a systematic review of the literature regarding the endovascular management of PSA stenosis and occlusion was conducted.
Collapse
Affiliation(s)
- Erica Mariani
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Andrea Andreone
- Interventional Radiology, Department of Diagnostic Radiology, University Hospital of Parma, Parma, Italy
| | - Paolo Perini
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University Hospital of Parma, Parma, Italy
| | - Matteo Azzarone
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alessandro Ucci
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Antonio Freyrie
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| |
Collapse
|
4
|
Ucci A, D'Ospina RM, Perini P, Bianchini Massoni C, De Troia A, Azzarone M, Bridelli F, Bellini V, Bignami E, Freyrie A. Twelve years of experience in carotid endarterectomy with general anesthesia and preserved consciousness. INT ANGIOL 2021; 39:477-484. [PMID: 33440925 DOI: 10.23736/s0392-9590.20.04427-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Carotid endarterectomy (CEA) can be performed both under general anesthesia (GA) or local anesthesia (LA) with good results. General anesthesia with preserved consciousness (GAPC) using remifentanil infusion has been already reported in literature and could potentially merge the advantages of GA and LA overcoming the disadvantages of this last technique. Although the good results of GAPC reported in literature, this technique is not widespread in clinical practice. The aim of this study was to report the perioperative results of CEA under GAPC in a large series of consecutive patients. METHODS This is a retrospective, single center, observational study including all patients treated for CEA under GAPC in our institution between January 2008 and October 2019. Primary endpoints were neurological complications rate, mortality rate in the perioperative period, need to GAPC conversion to GA during surgery and evaluation of the technique with a specific questionnaire regarding patients' satisfaction. Secondary endpoints were myocardial infarction (MI) rate, other perioperative complications rate, rate of intraoperative shunting and need of reintervention in the perioperative period. RESULTS In the considered period 1290 CEA under GAPC were performed and included in this study. Neurological complications rate was 2.01%, mortality rate in the perioperative period was 0.07%, need of GAPC conversion to GA rate during surgery was 0.46% and patients satisfaction regarding the technique were high with a mean vote of 9.1 in a 0 to 10 scale. In the perioperative period MI rate was 0.23%, other perioperative complications rate was 1.39%, intraoperative shunting rate was 7.1% and reintervention rate after surgery was 2.4%. CONCLUSIONS CEA under GAPC may combine the advantages of LA and GA, with a very low rate of conversion to GA during surgery and good patients' satisfaction. Moreover, it does not increase neurological, cardiologic and systemic complications. For these reasons CEA under GAPC could represents a valid alternative to GA or LA.
Collapse
Affiliation(s)
- Alessandro Ucci
- Section of Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy -
| | - Rita M D'Ospina
- Section of Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paolo Perini
- Section of Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Alessandro De Troia
- Section of Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Matteo Azzarone
- Section of Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | | | - Elena Bignami
- ICU Department, Parma University Hospital, Parma, Italy
| | - Antonio Freyrie
- Section of Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| |
Collapse
|
5
|
Affiliation(s)
- Paolo Perini
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy; Vascular Surgery, Cardio-Thoracic and Vascular Department, University Hospital of Parma, Parma 43126, Italy.
| | - Bilal Nabulsi
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University Hospital of Parma, Parma 43126, Italy
| | - Claudio Bianchini Massoni
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University Hospital of Parma, Parma 43126, Italy
| | - Matteo Azzarone
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Antonio Freyrie
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| |
Collapse
|
6
|
Bianchini Massoni C, Ucci A, Perini P, Azzarone M, Mariani E, Bramucci A, D'Ospina RM, Freyrie A. Prevalence, risk factors and clinical impact of intraprosthetic thrombus deposits after EVAR. J Cardiovasc Surg (Torino) 2020; 61:729-737. [PMID: 32241093 DOI: 10.23736/s0021-9509.20.11267-9] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim was to define the prevalence, the evolution and the clinical relevance of the intraprosthetic thrombus deposit (IPT) after endovascular abdominal aortic repair (EVAR). METHODS Patients treated with EVAR from 2009 to 2017 for abdominal aortic aneurysm were retrospectively considered. Patients with at least one postoperative computed tomography angiography (CTA) performed after a 3-month follow-up were included. Postoperative medical therapy (antiplatelet and/or oral anticoagulant) were recorded. Aorto-iliac anatomical characteristics were measured on pre-operative CTA, while structural and dimensional endograft features were extracted from instructions for use. IPT was defined as intra-endograft thrombus with minimum thickness of 2mm and longitudinally extended for minimum 4 mm, and was assessed in all postoperative CTA. Primary endpoints were freedom from IPT occurrence, risk factors for IPT and evolution of IPT. Secondary endpoints were the prevalence of overall and IPT-related tromboembolic events (TEE: main-body or limb occlusion, distal embolization) during follow-up and its correlation with IPT. RESULTS Two-hundred twenty-one patients (mean age 76±7 years; male 94%) were included. Deployed endografts were: aorto-biiliac 96%, aorto-uniiliac 3%, aortic tube 1%; dacron 90%, ePTFE 10%. Mean follow-up was 30±25 months. Overall IPT prevalence was 36% (80/221). At 6, 12, 24 and 48 months, overall estimated freedom from IPT occurrence was 86%, 80%, 60% and 52%, respectively (Kaplan-Meier analysis). At Cox uni-variate analysis, postoperative medical therapy has no influence on IPT; aorto-iliac anatomical risk factors for IPT were larger neck diameter (P<0.001), severe neck thrombus (P=0.043), higher percentage of sac thrombus (P<0.001), hypogastric occlusion/coverage (P=0.040); endograft risk factors were proximal diameter ≥30mm (P<0.001), longer main body (P=0.002), dacron fabric (P=0.025), higher ratio between main body area/gate areas and main body area/distal iliac areas (P<0.001 and P<0.001, respectively). At Cox multi-variate analysis, independent risk factors for IPT were larger neck diameter (P=0.003), higher percentage of sac thrombus (P=0.005) and longer main body (P=0.028). During follow-up, IPT disappeared in 14 cases (18%). Overall TEE prevalence was 4% (8/221) and overall estimated freedom from TEE occurrence at 6, 12, 24 and 48 months was 99%, 99%, 95.3%, 94.1%, respectively (Kaplan-Meier analysis). TEE was IPT-related in 5/8 cases (63%). No statistical correlation were found between IPT and TEE. CONCLUSIONS The development of intraprosthetic graft thrombus (IPT) is a frequent event after EVAR. The risk of IPT is closely correlated with the proximal aortic neck size, the presence of intra-aneurysmal sac thrombus, and the length of the endograft main body. However, there was no statistical correlation between the presence of IPT and TEE.
Collapse
Affiliation(s)
- Claudio Bianchini Massoni
- Section of Vascular Surgery, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy -
| | - Alessandro Ucci
- Section of Vascular Surgery, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Paolo Perini
- Section of Vascular Surgery, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Matteo Azzarone
- Section of Vascular Surgery, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Erica Mariani
- Section of Vascular Surgery, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Alberto Bramucci
- Section of Vascular Surgery, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Rita M D'Ospina
- Section of Vascular Surgery, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Antonio Freyrie
- Section of Vascular Surgery, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| |
Collapse
|
7
|
Perini P, Bianchini Massoni C, Mariani E, Ucci A, Fanelli M, Azzarone M, Freyrie A. Systematic Review and Meta-Analysis of the Outcome of Different Treatments for Type 1a Endoleak After EVAR. Ann Vasc Surg 2019; 60:435-446.e1. [DOI: 10.1016/j.avsg.2019.03.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/04/2019] [Accepted: 03/11/2019] [Indexed: 12/29/2022]
|
8
|
Perini P, Bianchini Massoni C, Mariani E, D'ospina RM, Rossi G, Carli AG, Bramucci A, Azzarone M, Freyrie A. Late open conversions after failed EVAR. Ital J Vasc Endovasc Surg 2019. [DOI: 10.23736/s1824-4777.19.01419-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
9
|
Massoni CB, Ucci A, Perini P, Azzarone M, Mariani E, Bramucci A, D'Ospina RM, Freyrie A. SS25. Prevalence, Risk Factors, and Clinical Impact of Intraprosthetic Thrombus Deposits After Endovascular Aneurysm Repair. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.04.289] [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] [Indexed: 11/24/2022]
|
10
|
Bianchini Massoni C, Perini P, Fanelli M, Ucci A, Rossi G, Azzarone M, Tecchio T, Freyrie A. Intraoperative contrast-enhanced ultrasound for early diagnosis of endoleaks during endovascular abdominal aortic aneurysm repair. J Vasc Surg 2019; 70:1844-1850. [PMID: 31147132 DOI: 10.1016/j.jvs.2019.02.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 08/18/2018] [Accepted: 02/12/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the feasibility and utility of intraoperative contrast-enhanced ultrasound (CEUS) for early detection of endoleaks (ELs) during endovascular abdominal aortic aneurysm repair (EVAR) compared with completion digital subtraction angiography. METHODS Patients undergoing elective EVAR from January 2017 to April 2018 were consecutively enrolled in this prospective study. After endograft deployment, two-digital subtraction angiography (2DSA) with orthogonal C-arm angulations (anteroposterior and sagittal view) were routinely performed. After the endovascular treatment of clear, high-flow type I/III ELs detected by 2DSA, intraoperative CEUS was carried out in sterile conditions on the surgical field before guidewire removal. Presence and type of EL were evaluated with 2DSA and CEUS. CEUS was performed with the vascular surgeon blinded to the 2DSA findings. The primary end point was the level of agreement between 2DSA and CEUS to detect any type of EL and type II EL. Agreement between two diagnostic methods was calculated using Cohen's kappa. The secondary end point was utility of CEUS for intraoperative adjunctive procedure guidance. RESULTS Sixty patients were enrolled (mean age, 78 ± 6 years; 90% male). 2DSA revealed 11 ELs (18%; 1 type IA, 10 type II), and CEUS 25 ELs (42%; 2 type IA, 23 type II). 2DSA and CEUS were in agreement in 39 cases (65%; 32 no ELs, 7 type II ELs). CEUS detected 17 ELs not identified by 2DSA (28%; 2 type IA, 15 type II); 2DSA detected three ELs not identified by CEUS (5%; 3 type II). In one case, 2DSA and CEUS detected type II and type IA ELs, respectively. For EL and type II EL detection, Cohen's kappa was 0.255 and 0.250, respectively (both "fair agreement"). Intraoperative adjunctive sac embolization was performed under CEUS control in 4 cases and technical success was 100%. CONCLUSIONS Intraoperative CEUS during EVAR is feasible and can detect a greater number of ELs than 2DSA, in particular type II ELs. Further studies are necessary to assess the reliability of this intraoperative diagnostic examination. In type II ELs, CEUS may represent an additional, useful tool for intraoperative sac embolization guidance.
Collapse
Affiliation(s)
| | - Paolo Perini
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Mara Fanelli
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Alessandro Ucci
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Giulia Rossi
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Matteo Azzarone
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Tiziano Tecchio
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Antonio Freyrie
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| |
Collapse
|
11
|
Fanelli M, Perini P, Bianchini Massoni C, Bramucci A, Epifani E, Azzarone M, D'ospina R, Nabulsi B, Rossi G, Ucci A, Freyrie A. Carotid cross-clamping intolerance during carotid endarterectomy: the role of Willis' Circle variations. Ital J Vasc Endovasc Surg 2019. [DOI: 10.23736/s1824-4777.19.01406-2] [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] [Indexed: 11/08/2022]
|
12
|
Nabulsi B, Bianchini Massoni C, Tecchio T, Ucci A, Rossi G, Perini P, Azzarone M, De Troia A, Freyrie A. Endovascular repair of an abdominal aortic aneurysm using bifurcated stent-graft in a patient with bilateral external iliac artery occlusion. Acta Biomed 2019; 90:122-126. [PMID: 30889166 PMCID: PMC6502168 DOI: 10.23750/abm.v90i1.6605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 07/22/2017] [Indexed: 11/23/2022]
Abstract
Abdominal aortic aneurysm (AAA) in association with external iliac artery (EIA) occlusion is a rare entity which may limit endovascular aortic aneurysm repair (EVAR) feasibility. We describe the case of an 84-year-old man affected by a 64mm infrarenal inflammatory abdominal aortic aneurysm with complete bilateral occlusion of EIA and patency of both common and internal iliac arteries. The common femoral arteries (CFA) were patent, and the patient was asymptomatic for lower limb claudication. The treatment was performed by EVAR using a bifurcated stent-graft after the recanalization of the left EIA, achieving technical success.
Collapse
Affiliation(s)
- Bilal Nabulsi
- Department: Vascular Surgery - Department of Surgical Sciences Institution: Azienda Ospedaliero-Universitaria di Parma Via Gramsci 14 - 43126 Parma (PR) Country: Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Bianchini Massoni C, Mascoli C, Perini P, Tecchio T, Gallitto E, Azzarone M, Gargiulo M, Freyrie A, Faggioli G, Stella A. Endovascular treatments for type Ib endoleaks after aorto-iliac aneurysms exclusion: mid-term results. INT ANGIOL 2018; 37:384-389. [DOI: 10.23736/s0392-9590.18.04024-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
14
|
Perini P, Bianchini Massoni C, Azzarone M, Ucci A, Rossi G, Gallitto E, Freyrie A. Significance and Risk Factors for Intraprosthetic Mural Thrombus in Abdominal Aortic Endografts: A Systematic Review and Meta-analysis. Ann Vasc Surg 2018; 53:234-242. [PMID: 30012445 DOI: 10.1016/j.avsg.2018.04.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/12/2018] [Accepted: 04/19/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The detection of intraprosthetic thrombus (IPT) deposits is a common finding during follow-up for endovascular abdominal aneurysm repair (EVAR); however, its clinical significance is still debated. The aim of this study was to determine if IPT represents a risk factor for thromboembolic events (TEs; endograft or limb thrombosis, or distal embolization) after EVAR. METHODS A systematic review of English literature was undertaken until November 2017. Studies providing 2-group comparison (patients with IPT development on postoperative computed tomography angiography versus patients without IPT) with extractable outcome data (TE related to IPT and/or risk factors for IPT development) were included. Meta-analysis was performed when comparative data were given in 2 or more articles. RESULTS Five single-center studies (808 patients) were analyzed. IPT detection at any time during follow-up occurred in 20.8% (168/808) of patients. Extractable data for postoperative TE were available in 4 studies (613 patients): on comparative meta-analysis, IPT was not significantly associated with TE occurrence during follow-up (odds ratio 2.25, 95% confidence interval [CI] 0.50-10.1; P = 0.29). IPT is generally detected during the first year after EVAR (maximum reported median: 12 months, range: 1.2-23). Polyester graft material (odds ratio 2.34, 95% CI 1.53-3.58; P < 0.001) and aorto-uni-iliac configuration of the endograft (odds ratio 3.27, 95% CI 1.66-6.44; P = 0.001) were confirmed as risk factors for IPT formation on meta-analysis. The literature systematic review suggests that IPT formation may be also associated with long main bodies and large necks. CONCLUSIONS IPT detection on postoperative computed tomography angiography was not significantly associated with the occurrence of TE over time. The aorto-uni-iliac configuration and the use of polyester fabric for endografts were confirmed as risk factors for IPT development.
Collapse
Affiliation(s)
- Paolo Perini
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | | | - Matteo Azzarone
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alessandro Ucci
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giulia Rossi
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Enrico Gallitto
- Vascular Surgery Unit, Dipartimento di Medicina Specialistica Diagnostica e Sperimentale (DIMES), Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Antonio Freyrie
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| |
Collapse
|
15
|
Massoni CB, Perini P, Ucci A, Rossi G, Fanelli M, Azzarone M, Tecchio T, Freyrie A. IP009. Intraoperative Contrast-Enhanced Ultrasound for Early Diagnosis and Treatment of Endoleaks During Endovascular Abdominal Aortic Aneurysm Repair∗. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.03.093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Ucci A, D'Ospina RM, Fanelli M, Rossi G, Persi F, Bridelli F, Tosi M, Bianchini Massoni C, Perini P, Nabulsi B, De Troia A, Tecchio T, Azzarone M, Freyrie A. One-year experience in carotid endarterectomy combining general anaesthesia with preserved consciousness and sequential carotid cross-clamping. Acta Biomed 2018; 89:61-66. [PMID: 29633744 PMCID: PMC6357616 DOI: 10.23750/abm.v89i1.6814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 10/21/2017] [Indexed: 11/23/2022]
Abstract
Background and aim of the work: We report 1-year single-centre experience in carotid endarterectomy (CEA) combining general anaesthesia with preserved consciousness (GAPC) and standardized carotid sequential cross-clamping, for our protocol effectiveness evaluation in reduction of perioperative stroke, death or cardiologic complications. Methods: We considered all patients who underwent CEA in 2016. All patients underwent superficial cervical plexus block and GAPC with Remifentanil. The surgical technique consisted of common carotid artery (CCA) cross-clamping, carotid bifurcation isolation, external (ECA) and internal carotid artery (ICA) cross-clamping. After CCA cross-clamping, we performed a neurological tolerance test (NTT); this allowed selective shunting only for positive NTT. Primary end-points were: transient ischemic attack (TIA)/stroke, myocardial infarction, death in perioperative period. Secondary end-points were: carotid shunting, peripheral cranial nerves injuries (PCNI), GAPC intolerance, other complications, reintervention in perioperative period, length of hospital stay. Results: 104 consecutive patients underwent CEA with this protocol in the considered period. Twenty-seven (25.9%) patients were symptomatic. Mean clamping time was 48±13.5 minutes. Five cases (4.8%) requested internal carotid artery shunting. No TIA/stroke, myocardial infarction or death were recorded in the perioperative period. PCNI were observed in 19 cases (18.2%) in the immediate post-operative period; 16 of them (84.2%) showed complete or partial resolution at discharge. Only one patient (0.9%) showed GAPC intolerance. No other complication occurred. Three patients (2.9%) underwent reintervention for neck haematoma drainage. Mean hospital stay were 3±0.9 days. Conclusions: GAPC associated with sequential carotid cross-clamping appeared to be safe and effective in prevention of major neurological and cardiologic complications during CEA. (www.actabiomedica.it)
Collapse
Affiliation(s)
- Alessandro Ucci
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Rita Maria D'Ospina
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Mara Fanelli
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Giulia Rossi
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Federica Persi
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Franca Bridelli
- Anaesthesiology, Intensive Care and Pain Therapy, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Michela Tosi
- Anaesthesiology, Intensive Care and Pain Therapy, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Claudio Bianchini Massoni
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Paolo Perini
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Bilal Nabulsi
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Alessandro De Troia
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Tiziano Tecchio
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Matteo Azzarone
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Antonio Freyrie
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| |
Collapse
|
18
|
Bianchini Massoni C, Azzarone M, Barbarisi D, Perini P, Freyrie A. Ruptured Abdominal Aortic Aneurysm in a Patient with Congenital Fused Pelvic Kidney: A Case Report of Emergency Endovascular Treatment. Aorta (Stamford) 2018; 6:21-27. [PMID: 30079933 PMCID: PMC6136674 DOI: 10.1055/s-0038-1636992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 90-year-old male developed acute onset of abdominal and lumbar pain due to the rupture of an 11-cm abdominal aortic aneurysm. A congenital fused pelvic kidney perfused by three renal arteries arising from iliac axes was detected. In an emergent setting, an aorto-uni-iliac endograft was deployed through right femoral surgical access with occlusion of the upper right renal artery. An occluder device was placed in the common iliac artery above the renal artery through left femoral access. A femorofemoral crossover bypass completed the procedure. The patient developed acute renal failure, with no dialysis necessity. One-month computed tomography angiography showed procedure success.
Collapse
Affiliation(s)
- Claudio Bianchini Massoni
- Vascular Surgery - Department of Surgical Sciences, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Matteo Azzarone
- Vascular Surgery - Department of Surgical Sciences, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Danilo Barbarisi
- Vascular Surgery - Department of Surgical Sciences, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Paolo Perini
- Vascular Surgery - Department of Surgical Sciences, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Antonio Freyrie
- Vascular Surgery - Department of Surgical Sciences, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| |
Collapse
|
19
|
Perini P, de Troia A, Tecchio T, Azzarone M, Bianchini Massoni C, Salcuni P, Freyrie A. Infrarenal endograft clamping in late open conversions after endovascular abdominal aneurysm repair. J Vasc Surg 2017; 66:1048-1055. [DOI: 10.1016/j.jvs.2017.01.057] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 01/31/2017] [Indexed: 10/19/2022]
|
20
|
Bianchini Massoni C, Freyrie A, Gargiulo M, Tecchio T, Mascoli C, Gallitto E, Faggioli G, Pini R, Azzarone M, Perini P, Stella A. Perioperative and Late Outcomes after Endovascular Treatment for Isolated Iliac Artery Aneurysms. Ann Vasc Surg 2017; 44:83-93. [DOI: 10.1016/j.avsg.2017.03.194] [Citation(s) in RCA: 10] [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: 10/05/2016] [Revised: 02/21/2017] [Accepted: 03/28/2017] [Indexed: 11/30/2022]
|
21
|
Bianchini Massoni C, Perini P, Tecchio T, Azzarone M, de Troia A, Freyrie A. A systematic review of treatment modalities and outcomes of type Ib endoleak after endovascular abdominal aneurysm repair. Vascular 2017; 26:90-98. [DOI: 10.1177/1708538117726468] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To collect specific literature on type Ib endoleak after aorto-iliac endografting for abdominal aortic aneurysm, reporting data on diagnosis, treatment, and follow-up results. Methods Publications about type Ib endoleak after aorto-iliac endografting for abdominal aortic or iliac aneurysm were searched in PubMed, Web of Science, and Scopus. Considered studies were in English and published until 3 November 2016. Research methods and reporting were performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Inclusion criteria were: (1) reporting on abdominal aortic or iliac aneurysm as primary diagnosis; (2) reporting on distal endoleak after aorto-iliac endografting. Patient data, data on endovascular treatment, endoleak, reintervention, and follow-up were collected by two independent authors. Results Included studies were 11 (five original articles, six case reports), corresponding to 29 patients and 30 type Ib endoleak. Excluding missing data (2/30, 6.7%), type Ib endoleak was treated intra-operatively, within six months and after six months in six cases (21.4%), eight cases (28.6%), and fourteen cases (50%), respectively. Treatment of type Ib endoleak was endovascular in 27 cases (90%) (7 embolizations + extender cuffs, 10 extender cuffs, 8 embolizations without extender cuff, 1 Palmaz stenting and 1 iliac branched endograft), hybrid in 1 case (3.3%) and surgical in 2 cases (6.6%). Buttock claudication occurred in two cases (6.7%). One-month mortality was 3.4% (2/29) without events due to type Ib endoleak. In 14 cases (46.7%), median follow-up was six months (interquartile range: 2.75–14; range: 0.75–53). Type Ib endoleak persisted or reappeared in three cases (10%), all after endovascular treatment. Two of these (2/3, 66.7%) needed endovascular reintervention. No death during follow-up was reported. Conclusions Few specific data are available in literature about type Ib endoleak after aorto-iliac endografting for abdominal aortic aneurysm. About 50% of type Ib endoleak occurred after six months from the endovascular abdominal aneurysm repair procedure. Treatment is mainly endovascular and distal endograft extension is the main and effective treatment. Buttock claudication is the most frequent complication in case of exclusion of internal iliac artery. Persistent type Ib endoleak is possible, and adjunctive endovascular procedures are necessary.
Collapse
Affiliation(s)
| | - Paolo Perini
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Tiziano Tecchio
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Matteo Azzarone
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Alessandro de Troia
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Antonio Freyrie
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| |
Collapse
|
22
|
de Troia A, Mottini F, Biasi L, Azzarone M, Tecchio T, Salcuni P. Superior Mesenteric Artery Aneurysm Caused by Aortic Valve Endocarditis. Vasc Endovascular Surg 2016; 50:88-93. [DOI: 10.1177/1538574415627867] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Infectious aneurysms of the superior mesenteric artery are a rare but life-threatening condition due to the risk of visceral ischemia, sepsis, or hemorrhage. In this study, we report the case of a superior mesenteric artery aneurysm (SMAA) secondary to a bioprosthetic valve endocarditis, successfully managed with aneurysm resection and saphenous vein interposition graft. We performed an extensive PubMed-based rewiew of the literature of the last 10 years on SMAA, which include the detection of 38 articles quoting 41 SMAAs. The case histories were divided in 2 groups: 18 cases belonged to nonmycotic group A and 23 cases were included in mycotic group B. In group A, 44.4% of patients were treated surgically, whereas in group B, 90.5%. The 2 study groups significantly differed ( P = .01) in terms of surgical treatment. The surgical approach still remains the first choice of treatment in mycotic aneurysm.
Collapse
Affiliation(s)
- Alessandro de Troia
- Unit of Vascular Surgery, Department of Surgical Sciences University Hospital of Parma, Italy
| | - Francesca Mottini
- Unit of Vascular Surgery, Department of Surgical Sciences University Hospital of Parma, Italy
| | - Lukla Biasi
- Unit of Vascular Surgery, Department of Surgical Sciences University Hospital of Parma, Italy
| | - Matteo Azzarone
- Unit of Vascular Surgery, Department of Surgical Sciences University Hospital of Parma, Italy
| | - Tiziano Tecchio
- Unit of Vascular Surgery, Department of Surgical Sciences University Hospital of Parma, Italy
| | - PierFranco Salcuni
- Unit of Vascular Surgery, Department of Surgical Sciences University Hospital of Parma, Italy
| |
Collapse
|
23
|
Tsialtas D, Bolognesi MG, Tecchio T, Azzarone M, Quaini F, Bolognesi R. Clinical, electrocardiographic and echocardiographic features in patients with major arterial vascular disease assigned to surgical revascularization. VASA 2015; 43:443-9. [PMID: 25339162 DOI: 10.1024/0301-1526/a000391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 11/19/2022]
Abstract
BACKGROUND Preoperative cardiac assessment may essentially contribute to estimate the operative risk in vascular surgery.This study was undertaken to depict the clinical conditions and cardiac status in patients before elective major vascular surgery. PATIENTS AND METHODS 143 patients with asymptomatic critical aortic abdominal aneurysm, 119 with high-grade carotid stenosis, and 138 with advanced symptomatic ischemia due to peripheral artery disease were assigned to surgical revascularization. Preoperatively, all subjects completed detailed medical history, physical and laboratory examinations, electrocardiogram, and transthoracic echocardiography. RESULTS In patients with peripheral artery disease we identified more smokers (p < 0.05), diabetes (p < 0.01), hypertriglyceridemia (p < 0.05), previous myocardial infarction (p < 0.01); the asymptomatic aortic abdominal aneurysm group had a higher body mass index (p < 0.05), diastolic hypertension (p < 0.05), and most had left ventricular anterior hemiblocks (p < 0.001). Patients with critical carotid stenosis were older (p < 0.01), with greater systolic hypertension (p < 0.01), and with a less compromised left ventricular systolic function. CONCLUSIONS Patients with peripheral artery disease were mostly affected by severe metabolic diseases and by worst cardiac conditions; patients with asymptomatic abdominal aortic aneurysms were of robust physique, and often had left ventricular anterior hemiblocks. Patients with critical carotid stenosis were older and had less cardiomyopathies.
Collapse
|
24
|
de Troia A, Biasi L, Iazzolino L, Azzarone M, Tecchio T, Rossi C, Salcuni P. Endovascular Stent Grafting of a Posterior Tibial Artery Pseudoaneurysm Secondary to Penetrating Trauma: Case Report and Review of the Literature. Ann Vasc Surg 2014; 28:1789.e13-7. [DOI: 10.1016/j.avsg.2014.02.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 02/04/2014] [Accepted: 02/04/2014] [Indexed: 11/25/2022]
|
25
|
Savonitto S, Azzarone M, Salsi R, Tortorella G. [The new ESC guidelines for non-ST-elevation acute coronary syndromes: one direction, many ways, clinical wisdom]. G Ital Cardiol (Rome) 2013; 13:157-68. [PMID: 22395106 DOI: 10.1714/1038.11320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The 2011 edition of the ESC guidelines on non-ST-segment elevation acute coronary syndromes (NSTE-ACS) maintains the approach strongly based upon risk stratification, following the concept that "the higher the risk of ischemic events, the larger will be the benefit of an aggressive pharmaco-interventional approach". This concept applies both to the indication and timing of angiography/revascularization and to the choice of concomitant pharmacological therapies. The proofs of efficacy of the most recent drug treatments are solid, but the choice among the several available options and the evaluation of the efficacy/safety ratios in patient subsets require clinical wisdom, especially for the management of the most complex and frail patients. The indication for performing coronary angiography within 24h in high-risk patients would imply extending to NSTE-ACS patients the networks already in place for primary percutaneous coronary intervention in ST-elevation myocardial infarction.
Collapse
|
26
|
de Troia A, Tecchio T, Azzarone M, Biasi L, Piazza P, Franco Salcuni P. Endovascular Treatment of an Innominate Artery Iatrogenic Pseudoaneurysm Following Subclavian Vein Catheterization. Vasc Endovascular Surg 2010; 45:78-82. [DOI: 10.1177/1538574410388308] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Central venous catheterization is routinely required in a wide range of clinical situations such as hemodynamic monitoring, delivery of blood products and drugs, hemodialysis, total parental nutrition, and management of perioperative fluids. Pseudoaneurysms account for 4% of all innominate artery aneurysms. Clinical presentation may include airway and neurological compression, chest pain, mediastinal syndrome, upper limb ischemia, and hemodynamic instability. We report what we believe is the first documented case of a successful endovascular stent-graft repair of an innominate artery iatrogenic pseudoaneurysm.
Collapse
Affiliation(s)
- Alessandro de Troia
- Unit of Vascular Surgery, Department of Surgical Sciences University Hospital of Parma, Italy,
| | - Tiziano Tecchio
- Unit of Vascular Surgery, Department of Surgical Sciences University Hospital of Parma, Italy
| | - Matteo Azzarone
- Unit of Vascular Surgery, Department of Surgical Sciences University Hospital of Parma, Italy
| | - Lukla Biasi
- Unit of Vascular Surgery, Department of Surgical Sciences University Hospital of Parma, Italy
| | - Paolo Piazza
- Department of Radiology University Hospital of Parma, Italy
| | - Pier Franco Salcuni
- Unit of Vascular Surgery, Department of Surgical Sciences University Hospital of Parma, Italy
| |
Collapse
|
27
|
Biasi L, Azzarone M, De Troia A, Salcuni P, Tecchio T. Extracranial Internal Carotid Artery Aneurysms: case report of a saccular wide-necked aneurysm and review of the literature. Acta Biomed 2008; 79:217-222. [PMID: 19260382] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE To describe a case of atherosclerotic Extracranial internal Carotid Artery Aneurysm (ECAA) with an unique "diverticulum-like" morphological structure, surgically treated and to review the experiences of major referral centers. CASE REPORT A 76-year-old woman presented with persistent dysphagia and transient hypophonia caused by a growing pulsatiling mass of the neck; duplex ultrasonography and angio-CT scan demonstrated a wide-necked, saccular aneurysm at the origin of the right Internal Carotid Artery (ICA). A total aneurysmectomy with patch angioplasty of the aneurysm of the neck on the carotid wall was successfully performed. No perioperative complications were encountered; at one year follow-up the patient was asymptomatic without any neurological complication and with carotid patency. CONCLUSIONS Open surgery remains the gold standard for the treatment of extracranial internal carotid artery aneurysms in terms of patency and reduced risk of adverse complications; endovascular procedures may, in selected cases, provide a valuable additional tool in the armoury of the physician.
Collapse
Affiliation(s)
- Lukla Biasi
- Unit of Vascular Surgery, Department of Surgical Sciences, University of Parma, Parma, Italy.
| | | | | | | | | |
Collapse
|
28
|
De Troia A, Miosso F, Biasi L, Corona P, Tecchio T, Azzarone M, Pedrazzi G, Salcuni P. Carotid endarterectomy with mini-invasive access in locoregional anaesthesia. Acta Biomed 2008; 79:123-127. [PMID: 18788507] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM To assess the validity of a carotid endarterectomy (CEA) with a mini-invasive access via a 3-7 cm cutaneous incision in locoregional anaesthesia as a viable alternative to the traditional access with a cutaneous incision longer than 7 cm. MATERIALS AND METHODS We carried out a retrospective analysis of 76 consecutive patients (Group A) who had undergone carotid CEA in locoregional anaesthesia with cervical mini-access (3-7 cm incision), compared to a preceding series of 95 patients (Group B) who had undergone the same operation through a traditional access (incision > 7 cm). All patients in Group A were examined solely by means of duplex ultrasound scanning. RESULTS No mortality occurred in Group A and the morbidity rate was as follows: 1.3% strokes, 2.6% minor neurological events and 6.5% transitory deficit of peripheral nerves. In Group B, the mortality rate was 1%, with the following morbidity rate: 2% strokes, 1% minor neurological events and 7.3% transitory deficit of peripheral nerves. Statistical analysis revealed the two groups as being compatible for age, sex, associated pathologies and type of surgery. No statistically significant differences emerged between the two series of patients with regards to neurological morbidity or operative mortality. CONCLUSIONS In addition to being more aesthetically pleasing, mini-invasive access is a viable alternative to the traditional access for patients undergoing carotid CEA in locoregional anaesthesia.
Collapse
Affiliation(s)
- Alessandro De Troia
- Department of Surgical Sciences, Unit of Vascular Surgery, University of Parma, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Biggi A, Carra N, Cabassi A, Barilli AL, Musiari L, Iori M, De Iaco G, Azzarone M, Novarini A, Montanari A. Impaired renal haemodynamic response to L-arginine in essential hypertension: role of buffering anion and tubuloglomerular feedback. J Hypertens 2007; 25:679-88. [PMID: 17278985 DOI: 10.1097/hjh.0b013e3280117550] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To investigate whether changes in tubuloglomerular feedback (TGF) dependent upon the tubular effects of buffering anions affect the renal haemodynamic response to L-arginine in healthy (control) individuals and patients with essential hypertension. METHODS Mean arterial pressure (MAP), glomerular filtration rate (GFR), renal blood flow (RBF) and fractional excretion of sodium (FENa), chloride (FECl) and lithium (FELi) were measured in 10 control individuals and 10 hypertensive patients during two 3-h infusions of 0.012 mmol/kg per min L-arginine buffered with either HCl or citric acid. RESULTS FELi, FECl and FENa increased (P < 0.001) comparably in controls and hypertensive individuals with arginine-HCl and decreased with arginine-citrate (P < 0.001). MAP was unchanged in controls with arginine-HCl and decreased by 3% with arginine-citrate (P < 0.001), and decreased in hypertensive individuals with both arginine-HCl and arginine-citrate (by 3 and 7%, respectively; P < 0.001). GFR increased with arginine-citrate in controls and hypertensive individuals (by 6.1 and 5.4%, respectively; P < 0.001), but did not change with arginine-HCl in controls and declined by 4.6% in hypertensive individuals (P < 0.05). RBF increased equally after arginine-citrate in controls and hypertensive individuals (by 34 and 33%, respectively; P < 0.001); it also increased after arginine-HCl (22 and 13%, respectively; P < 0.001), but less than after arginine-citrate (P < 0.001), and 41% less in hypertensive individuals than in controls (P < 0.001). DISCUSSION Because arginine-HCl, unlike arginine-citrate, inhibits tubular reabsorption and elicits much less renal vasodilatation than does arginine-citrate, renal haemodynamics in response to L-arginine are modulated by changes in reabsorption and TGF according to the tubular effects of the attendant anion. As renal vasodilatation in hypertensive individuals was reduced only with arginine-HCl, which activates TGF, the blunted vasodilatation of the hypertensive kidney in response to arginine-HCl reflects an exaggerated response to an activated TGF.
Collapse
Affiliation(s)
- Almerina Biggi
- Department of Clinical Sciences, University of Parma, Parma, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Salcuni P, Azzarone M, Biasi L, Mosso F, Orlandelli E, Tecchio T. Mini-invasive aortic surgery: a 2 year experience. Acta Biomed 2005; 76:28-32. [PMID: 16116822] [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] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The aim of this study was to evaluate a less invasive technique for the exposure of the infrarenal aorta and its impact on the treatment of patients with abdominal aortic aneurysms (AAA). Fortyfour patients with AAA we re prospectively selected f o r minilaparotomy a ortic exposure and repair using asmall periumbilical midline incision, intra-abdominal nondisplaced retraction of the small bowel and conventional hand-sewn vascular anastomosis. Perioperative comparisons with a contemporary group of AAA patients treated with long, open midline incision and extracavitary small bowel retraction were made. There were no significant differences between the minilaparotomy and open surgical control group concerning operating room time, intraoperative and perioperative morbidity or mortality. Significant differences were shown between the two groups regarding intensive care unit stay; the return to a general diet and the length of hospitalization. Minilaparotomy exposure is safe and effective for the treatment of infrarenal AAA. This technique maintains quality outcome while reducing postoperative ileus, hospital stay and resource utilization.
Collapse
|
31
|
Azzarone M, Cento M, Tecchio T, Paoletti G, Salcuni PF. [Ergot-induced upper limb ischemia: surgical treatment]. MINERVA CHIR 2004; 59:313-4. [PMID: 15252400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
|
32
|
Azzarone M, Cento M, Gobbi S, Tecchio T, Piazza P, Salcuni PF. Neuropathy as the only symptom of common carotid artery spontaneous rupture. Case report. J Cardiovasc Surg (Torino) 2003; 44:767-9. [PMID: 14994732] [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] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
We describe a case of a false aneurysm of the common carotid artery, caused by spontaneous carotid rupture, with atypical clinical presentation. The patient came to the our Hospital complaining of left shoulder pain and functional impairment of her left arm, during the past 20 days. The diagnostic work-up, color Doppler ultrasound, MR and angiography, evidenced a cervical false aneurysm; the electromyography showed denervation of the deltoid muscle, caused by cervical nerve roots compression. The therapeutic stages were initially an endovascular stent placement; then a surgical stage with evacuation for the hematoma and reconstruction of the carotid artery with saphenous graft.
Collapse
Affiliation(s)
- M Azzarone
- Vascular Surgery Unit, University of Parma, Italy.
| | | | | | | | | | | |
Collapse
|
33
|
Azzarone M, Cento M, Mazzei M, Tecchio T, Ugolotti U. Symptomatic Subtotal Occlusion of the Innominate Artery Treated With Balloon Angioplasty and Stenting. J Endovasc Ther 2000. [DOI: 10.1583/1545-1550(2000)007<0161:ssooti>2.3.co;2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
34
|
Azzarone M, Cento M, Mazzei M, Tecchio T, Ugolotti U. Symptomatic subtotal occlusion of the innominate artery treated with balloon angioplasty and stenting. J Endovasc Ther 2000; 7:161-4. [PMID: 10821105 DOI: 10.1177/152660280000700213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report the endovascular treatment of a subtotal occlusion of the innominate artery giving rise to subclavian steal syndrome. METHODS AND RESULTS A 60-year-old man in general good health was admitted to the hospital for sudden onset of amaurosis in the right eye. Thrombosis of the central retinal artery was diagnosed. Physical examination, color flow duplex imaging, and aortic arch angiography showed a subtotal occlusion of the innominate artery with right subclavian steal syndrome. One month later, balloon dilation and stenting of the innominate artery was performed through a right axillary access without cerebral protection. The innominate artery was recanalized with correction of the steal syndrome and restoration of the right radial pulse; no complications occurred. Twelve months later, color flow duplex sonography confirmed innominate stent patency and antegrade flow in the right vertebral artery. CONCLUSIONS Our experience supports the view that percutaneous endovascular techniques are appropriate and are the preferred treatment for lesions of the supra-aortic vessels. Continued surveillance will determine their long-term durability.
Collapse
Affiliation(s)
- M Azzarone
- Institute of General, Thoracic, and Vascular Surgery, University of Parma, Italy
| | | | | | | | | |
Collapse
|
35
|
Azzarone M, Tecchio T, Covizzi M, Solli P, Salcuni PF, Pellegrino F, Spaggiari L. [Infected aneurysms of the abdominal aorta. Personal case reports]. MINERVA CHIR 1998; 53:535-8. [PMID: 9774848] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Two cases of infected aneurysms of the subrenal abdominal aorta observed in the last year are reported. In this study some specific aspects of this unusual pathology are analyzed: the high mortality rate, the difficulties involved in the diagnosis and the surgical solutions.
Collapse
Affiliation(s)
- M Azzarone
- Clinica Chirurgica Generale Toracica e Vascolare, Università degli Studi, Parma
| | | | | | | | | | | | | |
Collapse
|
36
|
Solli P, Benincasa A, Azzarone M, Tecchio T, Berardi G, Spaggiari L, Formato L, Salcuni PF. [Consumption coagulopathy associated with a case of an abdominal aortic aneurysm]. MINERVA CHIR 1997; 52:1231-5. [PMID: 9471578] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Consumption coagulopathy with clinical symptoms reveals aortic arterial aneurysms in less than 5% of cases. The authors report a case of abdominal aortic aneurysm: surgical repair is able to remove the hemostasis abnormalities for a long time. Implications of the consumption coagulopathy are analyzed: diagnosis, preoperative correction of the coagulopathy, surgical technique.
Collapse
Affiliation(s)
- P Solli
- Cattedra di Chirurgia Vascolare, Università degli Studi, Parma
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Bolognesi R, Tiberti G, Azzarone M, Tecchio T, Pellegrino F, Manca C. Clinical, electrocardiographic, and echocardiographic features in patients with asymptomatic aortic abdominal aneurysm. Angiology 1996; 47:1139-44. [PMID: 8956665 DOI: 10.1177/000331979604701203] [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] [Indexed: 02/03/2023]
Abstract
Cardiac involvement in peripheral vascular diseases can present interesting patho-physiological aspects and can influence the prognosis. The authors evaluated the cardiac condition of patients with asymptomatic aortic abdominal aneurysm (AAAA) by using clinical, electrocardiographic, and echocardiographic techniques. Seventy-eight patients were studied, 74 men and 4 women, with ages ranging from fifty-five to eighty-one years (mean 69.5 +/- 6.4). All patients were submitted to a complete clinical examination, usual blood tests, a 12-lead resting electrocardiogram, and an echo-Doppler evaluation. Forty-eight subjects (61.5%) were affected by hypertension, 53 (67.9%) were smokers, 25 (32.1%) were alcohol abusers, 39 (50%) had a history of angina pectoris, 20 (25.6%) had had previous myocardial infarction, and 30 (38.5%) were receiving active cardiovascular treatment. All patients except 2, who had chronic atrial fibrillation, manifested sinus rhythm. Electrocardiographic signs of left ventricular (LV) hypertrophy were present in 20 cases (25.6%), intraventricular conduction disturbances in 19 (24.4%), pathological Q waves in 20 (25.6%), and primary repolarization abnormalities in 25 (32.1%). Echocardiography showed a slight increase in left atrial diameter and intraventricular septum thickness (41.5 +/- 4.3 and 12.3 +/- 2 mm respectively). A clearer increase was found in LV mass index (159 +/- 44 g/m2). In 31 patients one or more LV asynergic segments were found. In our patients with AAAA the prevalence of major risk factors for atherosclerosis and ischemic heart disease including previous myocardial infarction was high. Echo-derived LV myocardial mass index was higher than normal even though electrocardiographic criteria for LV hypertrophy did not match echocardiographic data in all subjects. Finally a moderate prevalence of intraventricular conduction disturbances was recorded.
Collapse
Affiliation(s)
- R Bolognesi
- Cattedra di Cardiologia, Università degli Studi di Parma, Italy
| | | | | | | | | | | |
Collapse
|
38
|
Azzarone M, Berni Canani M, Nahas MA, Benincasa A, Salcuni PF, Tecchio T. [Pseudo-occlusions of the internal carotid artery]. Ann Ital Chir 1996; 67:621-5; discussion 626. [PMID: 9036820] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The pseudo-occlusion (P.O.) of the internal carotid artery is defined as an atheromatous lesion causing a high-grade stenosis, which describes a peculiar angiographic finding ("string sing" or "slim sign"). The authors report their experience with 6 P.O. (angiographically diagnosed) that had been found in 16 months. In all these cases, whenever there was a clinical e/or B-scan ultrasound suspect, angiographic recommendations for the detection of that lesion have been applied. One of these 6 patients, clinically asymptomatic, refused surgery, remaining asymptomatic for cerebral ischemia during the successive 16 months; angiographic control evidenced an unmodified P.O. The other 5 patients, clinically symptomatic, underwent surgical correction: in one, intraoperative finding was a total carotid occlusion. In the other 4 patients the P.O. was confirmed and an endoarterectomy has been done. No immediate or later complications have been noted (clinical and ultrasonographic average follow-up time was 12 months). The experience described by the authors leeds to some considerations: a) the carotid P.O. is not so rare; specially if adequate angiographic technique has been employed; b) the non-invasive studies could not reliably distinguish a P.O; c) intraoperative findings do not confirm, always, angiographic ones but a fibrous, chronic and totally occluded internal carotid artery; d) the evolution of P.O. in a complete carotid occlusion is very probable but not obligatory, and if this happens it needs long period of time; consequently the surgical correction of P.O. could be justified but not urgently; e) the surgical correction of the P.O. can be done without particular difficulty and its outcome is so similar to those obtained from the routine carotid surgery.
Collapse
Affiliation(s)
- M Azzarone
- Istituto di Clinica Chirurgica Generale Toracica e Vascolare, Università degli Studi di Parma
| | | | | | | | | | | |
Collapse
|
39
|
Salcuni PF, Spaggiari L, Tecchio T, Benincasa A, Azzarone M. Hepatic artery aneurysm: an ever present danger. J Cardiovasc Surg (Torino) 1995; 36:595-9. [PMID: 8632033] [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] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Hepatic artery aneurysms are infrequent vascular lesions, difficult to diagnose preoperatively manifesting themselves usually by acute rupture. We report our experience in both diagnosis and surgical treatment of 3 cases. The selective angiograph of the celiac tripod and of superior mesenteric artery, is an indispensable means able, not only to put forward a certain diagnosis, but also to supply precious notions on the possibilities of compensation on the side of the collateral circle and of consequence, to suggest operative tactics. Surgical management may range from the simple binding to the reconstruction of the hepatic arterial axis by means of prosthesis grafts and if possible to the simple excision and termino-terminal regraft.
Collapse
Affiliation(s)
- P F Salcuni
- Department of General Thoracic and Vascular Surgery, University of Parma, Italy
| | | | | | | | | |
Collapse
|
40
|
Tecchio T, Azzarone M, Nahas MA, Salcuni P. [Reinterventions for arterial reconstruction in anastomotic aneurysm]. MINERVA CHIR 1992; 47:815-22. [PMID: 1620475] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We reviewed our experience on the surgical treatment of anastomotic false aneurysms from 1979 through 1990: two groups of patients were identified. Group 1 (31 patients) included patients who had been previously operated on at our Institute and then routinely followed-up with physical examination and ultrasonographic studies. The incidence of anastomotic aneurysm in this group was 4.03%; the interval between insertion of the prosthesis and detection of the false aneurysm varied from 5 to 144 months, with a median interval of 58 month. The surgical treatment of choice (false aneurysm resection and graft interposition) has been successfully performed (97% of cases) without mortality. Group 2 (8 patients) included patients with complications of false aneurysm (emergency operations); in this group radical treatment was not always applicable; mortality and amputations rate were significantly increased (respectively 25% and 37%). We conclude that, after prosthetic reconstructions, only a careful long-term follow-up (also with use of ultrasonic and/or CT-scan studies) may allow reduction in morbidity and improvement in late survival.
Collapse
Affiliation(s)
- T Tecchio
- Istituto di Clinica Chirurgica Generale, Università degli Studi di Parma
| | | | | | | |
Collapse
|
41
|
Frattini A, Ziveri M, Cortellini P, Monica B, Poletti F, Simonazzi M, Azzarone M. Compromissione Uro-Escretoria Da Atresia Segmentaria Della Vena Cava Inferiore. Urologia 1991. [DOI: 10.1177/039156039105800528] [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)
- A. Frattini
- (Divisione di Urologia U.S.L. n. 4 di Parma - Primario: prof. C. Macaluso, e 1a Clinica Chirurgica dell'Università degli Studi di Parma - Direttore: prof. P. Goffrini)
| | - M. Ziveri
- (Divisione di Urologia U.S.L. n. 4 di Parma - Primario: prof. C. Macaluso, e 1a Clinica Chirurgica dell'Università degli Studi di Parma - Direttore: prof. P. Goffrini)
| | - P. Cortellini
- (Divisione di Urologia U.S.L. n. 4 di Parma - Primario: prof. C. Macaluso, e 1a Clinica Chirurgica dell'Università degli Studi di Parma - Direttore: prof. P. Goffrini)
| | - B. Monica
- (Divisione di Urologia U.S.L. n. 4 di Parma - Primario: prof. C. Macaluso, e 1a Clinica Chirurgica dell'Università degli Studi di Parma - Direttore: prof. P. Goffrini)
| | - F. Poletti
- (Divisione di Urologia U.S.L. n. 4 di Parma - Primario: prof. C. Macaluso, e 1a Clinica Chirurgica dell'Università degli Studi di Parma - Direttore: prof. P. Goffrini)
| | - M. Simonazzi
- (Divisione di Urologia U.S.L. n. 4 di Parma - Primario: prof. C. Macaluso, e 1a Clinica Chirurgica dell'Università degli Studi di Parma - Direttore: prof. P. Goffrini)
| | | |
Collapse
|
42
|
Tecchio T, Salcuni P, Azzarone M, Soliani P. [A subclavian vein lesion due to the positioning of a chest tube via thoracostomy]. G Chir 1991; 12:435-7. [PMID: 1751336] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The authors describe an unusual complication of chest tube placement: subclavian vein lesion. After a literature review concerning complications of chest tube placement, the authors conclude that associated risks may be best minimized with a strict adherence to standardized technique and management protocol.
Collapse
Affiliation(s)
- T Tecchio
- Istituto di Clinica Chirurgica Generale, Toracica e Vascolare, Università degli Studi di Parma
| | | | | | | |
Collapse
|
43
|
Ugolotti U, Larini P, Marcato C, Azzarone M, Covizzi M. [A clinico-radiologic case of late occlusion of aortorenal bypass treated with locoregional thrombolysis]. Radiol Med 1991; 82:164-7. [PMID: 1896573] [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: 12/29/2022]
Affiliation(s)
- U Ugolotti
- Istituto di Scienze Radiologiche, Università degli Studi, Parma
| | | | | | | | | |
Collapse
|
44
|
Ugolotti U, Larini P, Mandrioli R, Miselli A, Villani LG, Japichino GG, Azzarone M. [Recanalization with laser and angioplasty of atherosclerotic lesions of the legs. Personal experience with 31 treated lesions]. Radiol Med 1991; 81:691-4. [PMID: 2057598] [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] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
From January to November 1989, 31 iliac and femoro-popliteal atherosclerotic lesions were treated in 29 patients (age range: 33-80 years) by means of percutaneous laser-assisted angioplasty. The lesions were 6 iliac tubular stenoses, 6 iliac occlusions and 19 femoro-popliteal occlusions, 2-20 cm long. The laser equipment employed was in 10 cases a Cardiolase 4000 Nd:YAG "hot tip" unit, and in 21 cases a Nd:YAG "sapphire contact probe" unit. Initial success was achieved in 23/31 lesions (74%); the follow-up, by clinical examination, Doppler US, and ankle-arm pressure index performed every 4th month, showed 1-year actuarial patency of 80% for femoro-popliteal occlusion and 100% for iliac lesion, with 87% cumulative patency. Overall complication rate was 22.5%. There were 6 local complications, 4 of which were hematomas at the arterial puncture site, and 2 were performation of the superficial femoral artery, all without any clinical sequelae; one patient developed rethrombosis within 72 hours from treatment, which needed amputation after an emergency bypass. Our preliminary results show no significant improvement when compared with conventional balloon angioplasty results both in immediate success rate and in short-to-midterm patency; furthermore, laser therapy was burdened by a higher complication rate. We believe that laser angioplasty should be employed only in arterial occlusion uncrossable with angiographic guidance alone.
Collapse
Affiliation(s)
- U Ugolotti
- II Servizio di Radiologia, Ospedale Regionale, Parma
| | | | | | | | | | | | | |
Collapse
|
45
|
Salcuni P, Azzarone M, Ugolotti U, Mandrioli R, Tecchio T. [An unusual case of a double location of arteriosclerotic aneurysms of the ulnar artery and anterior tibial artery]. Angiologia 1991; 43:1-6. [PMID: 2035880] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Multiple peripheral arteriosclerotic aneurysms are relatively rare. This is a report of a case of two arteriosclerotic aneurysms in unusual sites: ulnar artery and anterior tibial artery. Surgical treatment was: simple resection for the ulnar aneurysm; resection with restoration of arterial continuity for the tibial aneurysm.
Collapse
Affiliation(s)
- P Salcuni
- Istituto di Clinica Chirurgica Generale e Terapia Chirurgica, Università, Parma, Italia
| | | | | | | | | |
Collapse
|
46
|
Verardi S, Casciani CU, Nicora E, Forzano F, Origone A, Valle I, Catania G, Salanitri G, Salcuni P, Azzarone M. A multicentre study on LMW-heparin effectiveness in preventing postsurgical thrombosis. INT ANGIOL 1988; 7:19-24. [PMID: 2850322] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A multicentric study was carried out involving six italian departments of general surgery to assess the efficacy of a low molecular weight (LMW) heparin called Fluxum compared to standard calcium heparin in low doses for prevention of postoperative thromboembolic complications (deep vein thrombosis and pulmonary embolism). 610 patients were treated; 308 (50.5%) of whom were treated with Fluxum at doses of 4,000 or 8,000 I.U. Axa once a day by subcutaneous injection and 302 (49.5%) with heparin calcium at doses of 5,000 I.U. two or three times a day by subcutaneous injection. We observed a total of 29 deep vein thrombosis (4.7%); 10 (3.2%) from the group treated with LMW heparin and 19 (6.3%) from the comparative group. During the study 4 (0.65%) pulmonary embolism were found, 1 (0.32%) in the group treated with LMW heparin and 3 (1%) in the group treated with calcium heparin. None serious hemorrhagic accident was reported during the study. The antithrombotic prophy laxis carried out with Fluxum was on the whole better tolerated than the treatment of the other group, registering a lower frequency of hematomas at the injection and surgical wound sites.
Collapse
Affiliation(s)
- S Verardi
- General Surgery Clinics, II University, S. Eugenio Hospital, Roma
| | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Zola C, Dell'Abate P, Foggi E, Azzarone M. [Role of intraoperative choledochoscopy in surgery of biliary lithiasis]. G Chir 1988; 9:229-32. [PMID: 3153986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
48
|
Salcuni P, Azzarone M. [The use of LMW heparin in the prevention of thromboembolic disease in surgical patients: a controlled comparison with nonfractionated heparin]. Boll Chim Farm 1987; 126:2S-7S. [PMID: 2843203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
49
|
Azzarone M, Tecchio T, Salcuni PF, Pellegrino F. [Selection of the prosthetic material in extra-anatomic bypasses]. Angiologia 1986; 38:268-74. [PMID: 3789459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
50
|
Azzarone M. [Indiscriminate use of gonadotropins in the therapy of sterility in extraclinical circles]. Minerva Ginecol 1968; 20:1472-3. [PMID: 5754255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|