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Girolamo AD, Ascione M, Miceli F, Mohseni A, Pranteda C, Sirignano P, Taurino M, di Marzo L, Mansour W. Clinical and Radiological Outcomes of Accessory Renal Artery Exclusion during Endovascular Repair of Abdominal Aortic Aneurysms. Diagnostics (Basel) 2024; 14:864. [PMID: 38732277 PMCID: PMC11083523 DOI: 10.3390/diagnostics14090864] [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: 02/22/2024] [Revised: 04/06/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Accessory renal arteries (ARAs) frequently coexist with abdominal aortic aneurysms (AAA) and can influence treatment. This study aimed to retrospectively analyze the ARA's exclusion effect on patients undergoing standard endovascular aneurysm repair for AAA. METHODS The study focused on medium- and long-term outcomes, including type II endoleak, aneurysmal sac changes, mortality, reoperation rates, renal function, and infarction post-operatively. RESULTS 76 patients treated with EVAR for AAA were included. One hundred and two ARAs were identified: 69 originated from the neck, 30 from the sac, and 3 from the iliac arteries. The ARA treatment was embolization in 15 patients and coverage in 72. Technical success was 100%. One-month post-operative computed tomography angiography (CTA) revealed that 76 ARAs (74.51%) were excluded. Thirty-day complications included renal deterioration in 7 patients (9.21%) and a blood pressure increase in 15 (19.73%). During follow-up, 16 patients (21.05%) died, with three aneurysm-related deaths (3.94%). ARA-related type II endoleak (T2EL) was significantly associated with the ARA's origin in the aneurysmatic sac. Despite reinterventions were not significantly linked to any factor, post-operative renal infarction was correlated with an ARA diameter greater than 3 mm and ARA embolization. CONCLUSION ARAs can influence EVAR outcomes, with anatomical and procedural factors associated with T2EL and renal infarction. Further studies are needed to optimize the management of ARAs during EVAR.
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Affiliation(s)
- Alessia Di Girolamo
- Vascular and Endovascular Surgery Division, Department of General Surgery and Surgical Specialties, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (A.D.G.); (M.A.); (F.M.); (L.d.M.)
| | - Marta Ascione
- Vascular and Endovascular Surgery Division, Department of General Surgery and Surgical Specialties, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (A.D.G.); (M.A.); (F.M.); (L.d.M.)
| | - Francesca Miceli
- Vascular and Endovascular Surgery Division, Department of General Surgery and Surgical Specialties, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (A.D.G.); (M.A.); (F.M.); (L.d.M.)
| | - Alireza Mohseni
- Faculty of Medicine and Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy;
| | - Chiara Pranteda
- Vascular and Endovascular Surgery Unit, Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy; (C.P.); (P.S.); (M.T.)
| | - Pasqualino Sirignano
- Vascular and Endovascular Surgery Unit, Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy; (C.P.); (P.S.); (M.T.)
| | - Maurizio Taurino
- Vascular and Endovascular Surgery Unit, Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy; (C.P.); (P.S.); (M.T.)
| | - Luca di Marzo
- Vascular and Endovascular Surgery Division, Department of General Surgery and Surgical Specialties, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (A.D.G.); (M.A.); (F.M.); (L.d.M.)
| | - Wassim Mansour
- Vascular and Endovascular Surgery Division, Department of General Surgery and Surgical Specialties, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (A.D.G.); (M.A.); (F.M.); (L.d.M.)
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Piazza M, Squizzato F, Pratesi G, Parlani G, Simonte G, Giudice R, Mansour W, Veraldi GF, Gennai S, Antonello M. Outcomes of Off the Shelf Outer Branched Versus Inner Branched Endografts in the Treatment of Thoraco-Abdominal Aortic Aneurysm in the B.R.I.O. (BRanched Inner - Outer) Study Group. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00341-1. [PMID: 38636923 DOI: 10.1016/j.ejvs.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/25/2024] [Accepted: 04/10/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE This study aimed to compare two commercially available off the shelf branched endografts for thoraco-abdominal aortic aneurysm (TAAA) repair, namely the E-nside (Artivion) and Zenith t-Branch (Cook Medical) devices. METHODS This multicentre retrospective study (2020 - 2023) included patients treated by branched endovascular aortic repair (BEVAR) for TAAA using the inner branched E-nside or the outer branched t-Branch. Endpoints were 30 day technical success and major adverse events (MAEs) as well as one year freedom from target vessel instability and main endograft instability. RESULTS The study included 163 patients: 79 (307 target vessels) treated with E-nside and 84 (325 target vessels) with t-branch. Aneurysm extent was I - III in 91 patients (55.8%; 47% of E-nside and 66% of t-Branch) and IV in 72 patients (44.2%; 53% of E-nside and 34% of t-Branch) (p = .011). An adjunctive proximal thoracic endograft was used in 43% of E-nside vs. 69% of t-Branch (p < .001), with less frequent thoracic endografting (14% vs. 76%; p < .001) and shorter length of coverage (p = .024) in extent IV TAAA treated by E-nside. E-nside cases had shorter renal artery bridging lengths (66 ± 17 mm vs. 76 ± 20 mm; p < .010) and less frequent use of a distal bifurcated endograft (53% vs. 80%; p < .001). Comparing 30 day results, the mortality rate was 1% vs. 2% (p = .62), any MAE occurred in 18% vs. 21% (p = .55), the stroke rate was 3% vs. 0% (p = .23), and the elective spinal cord ischaemia rate was 5% vs. 8% (p = .40) for E-nside and t-Branch, respectively. At one year, freedom from target vessel instability was 96 ± 3% for E-nside and 95 ± 3% for t-Branch (p = .58), and freedom from endograft instability was 98 ± 2% vs. 97 ± 3% (p = .46), respectively. CONCLUSION Both off the shelf devices provided excellent early and one year results. The E-nside may require shorter thoracic aortic coverage and bridging length for the renal arteries, and less frequent implantation of a concomitant proximal thoracic or distal abdominal bifurcated endograft. However, these aspects did not determine significant differences in clinical outcomes.
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Affiliation(s)
- Michele Piazza
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | - Francesco Squizzato
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy. https://www.twitter.com/dr_fsquizzato
| | - Giovanni Pratesi
- Vascular and Endovascular Surgery Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianbattista Parlani
- Unit of Vascular and Endovascular Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Gioele Simonte
- Unit of Vascular and Endovascular Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Rocco Giudice
- Vascular and Endovascular Surgery Unit, San Giovanni Addolorata Hospital, Rome, Italy
| | - Wassim Mansour
- Vascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I -"La Sapienza" University of Rome, Rome, Italy
| | | | - Stefano Gennai
- Division of Vascular Surgery, University Hospital of Modena and Reggio Emilia, Baggiovara (MO), Italy
| | - Michele Antonello
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Mohseni A, Mansour W. Post-Traumatic Abdominal Aortic Pseudoaneurysm. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00099-6. [PMID: 38295940 DOI: 10.1016/j.ejvs.2024.01.072] [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: 10/04/2023] [Revised: 12/31/2023] [Accepted: 01/23/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Alireza Mohseni
- Department of General Surgery and Surgical Specialties, "Sapienza" University of Rome, Italy
| | - Wassim Mansour
- Department of General Surgery and Surgical Specialties, "Sapienza" University of Rome, Italy.
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Mohseni A, Di Girolamo A, Cangiano R, Ascione M, di Marzo L, Mansour W. High-Grade Infection after Branched Endovascular Aortic Repair in Patient with Recent COVID-19 Hospitalization. Diagnostics (Basel) 2024; 14:205. [PMID: 38248081 PMCID: PMC10814975 DOI: 10.3390/diagnostics14020205] [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: 11/02/2023] [Revised: 12/29/2023] [Accepted: 01/08/2024] [Indexed: 01/23/2024] Open
Abstract
In the context of the COVID-19 pandemic, the global healthcare landscape has undergone significant transformations, particularly impacting the management of complex medical conditions such as aortic aneurysms. This study focuses on a 76-year-old female patient with a history of extensive cardiovascular surgeries, including aortic valve replacement, Bentall operation, and Frozen Elephant Trunk procedure, who presented with a type II thoracoabdominal aortic aneurysm post-COVID-19 recovery. A comprehensive frailty assessment using the Modified Frailty Index and a two-phase endovascular approach for aneurysm treatment, considering the patient's frailty and complex medical history was performed. Upon successful aneurysm management, the patient's postoperative course was complicated by COVID-19 reinfection and Enterococcus faecalis superinfection, highlighting the increased risk of bacterial superinfections and the challenges posed by antimicrobial resistance in COVID-19 patients. The study underscores the necessity of vigilant postoperative surveillance and a multidisciplinary approach in managing such complex cases, highlighting the importance of personalized care strategies, integrating cardiovascular and infectious disease management, and adapting healthcare practices to the unique challenges of the pandemic. This case contributes to the evolution of knowledge on managing aortic aneurysms in the COVID-19 era, advocating for patient-centric treatment approaches and continuous research into long-term patient outcomes.
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Affiliation(s)
| | | | | | | | | | - Wassim Mansour
- Department of General Surgery and Surgical Specialties, “Sapienza” University of Rome, Policlinico Umberto I, Viale del Policlinico, 155, 00161 Rome, Italy; (A.M.); (A.D.G.); (R.C.); (M.A.); (L.d.M.)
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Melloni A, Bertoglio L, Van den Eynde W, Agrusa CJ, Parlani G, Howard DPJ, Rio J, Fazzini S, Mansour W, Dias NV, Ronchey S, Branzan D. Outcomes of Percutaneous Access to the First Versus Third Segment of Axillary Artery During Aortic Procedures. J Endovasc Ther 2023:15266028231202456. [PMID: 37750487 DOI: 10.1177/15266028231202456] [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: 09/27/2023]
Abstract
PURPOSE This article aims at investigating the outcomes of percutaneous access via the first versus third axillary artery (AXA) segments with closure devices during aortic procedures. MATERIALS AND METHODS All patients receiving percutaneous AXA access closed with Perclose ProGlide device (Abbott, Santa Clara, California) from 2008 to 2021 were included in a retrospective multicenter registry (NCT: 04589962). Efficacy endpoint was the technically successful percutaneous procedure (no open conversion). Safety endpoints were stroke and access complications according to the Valve Academic Research Consortium-3 reporting standards. The first (AXA1) or third (AXA3) axillary puncture sites were compared. RESULTS A total of 412 percutaneous AXA accesses were included: 172 (42%) in AXA1 and 240 (58%) in AXA3. Left AXA was catheterized in 363 cases (76% of AXA1 vs 97% of AXA3, p<0.001) and 91% of fenestrated/branched endovascular repair (F/BEVAR) procedures were conducted from the left. A ≥12F internal diameter (ID) sheath was used in 49% of procedures. Open conversion rate was 1%, no major vascular complications occurred, and only one major non-vascular complication was recorded. Primary closure failure occurred in 18 AXA1 (11%) and 32 AXA3 accesses (13%), treated by covered (8.3%) or bare-metal (2.7%) stenting. Bailout stent patency was 100% at median follow-up of 12 months, with 6 of 6 stents still patent after >36 months of follow-up. Stroke rate was 4.4%. An introducer sheath >12F was independently associated with both access complications (p<0.001) and stroke (p=0.005), while a right-side access was associated with stroke only (p=0.034). Even after adjustment for covariates, AXA1 versus AXA3 showed an equal success rate (odds ratio [OR]=0.537, 95% confidence interval [CI]=0.011-1.22 for AXA3, p=0.104). The combination of AXA3 and a >10F introducer sheath provided worse outcomes compared with >10F sheaths through AXA1 (OR for success=0.367, 95% CI=0.176-0.767, p=0.008). This was not confirmed for >12F sheaths, associated with similar outcomes (p=0.31 AXA 1 vs AXA 3). CONCLUSION Major local complications with the percutaneous axillary approach and ≤12F sheaths are infrequent and solvable by complementary endovascular interventions. Stroke risk remains an issue. First and third AXA segments are both amenable for access with good results, but larger sheaths (12F) perform better in AXA1. CLINICAL IMPACT Percutaneous access with vascular closure devices at the first or third axillary artery (AXA) segments during aortic procedures is burdened by a negligible risk of open conversion. Local complications with the percutaneous axillary approach are infrequent and solvable by complementary endovascular interventions. First and third AXA segments are both amenable to access with excellent results, but larger sheaths (12F) perform better in the wider first AXA segment. In this setting, bailout stenting does not appear to be associated with mid-term stent occlusion.
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Affiliation(s)
- Andrea Melloni
- Division of Vascular Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Bertoglio
- Division of Vascular Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Wouter Van den Eynde
- Department of Vascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium
| | - Christopher J Agrusa
- Division of Vascular Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Gianbattista Parlani
- Vascular and Endovascular Surgery Unit, S. Maria Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Dominic P J Howard
- Department of Vascular Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Javier Rio
- Servicio de Angiología y Cirugía Vascular, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Stefano Fazzini
- Vascular Surgery Unit, Biomedicine and Prevention Department, University of Rome Tor Vergata, Rome, Italy
| | - Wassim Mansour
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini," Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - Nuno V Dias
- Department of Thoracic Surgery and Vascular Diseases, Vascular Centre, Skåne University Hospital, Malmö, Sweden
| | - Sonia Ronchey
- Department of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy
| | - Daniela Branzan
- Department of Vascular Surgery, University Hospital Leipzig, and Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum Munich at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
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Di Girolamo A, Capoccia L, Dajci A, Grimaldi S, Mansour W, di Marzo L. Symptomatic Popliteal Artery Aneurysms in Recently Sars-CoV2-Infected Patients. J Vasc Surg 2023. [PMCID: PMC10019854 DOI: 10.1016/j.jvs.2023.01.097] [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: 03/18/2023]
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Berchiolli R, Troisi N, Bertagna G, Colli A, Besola L, Silingardi R, Simonte G, Isernia G, Lenti M, Parlani G, Fino G, Covic T, Gennai S, Ferri M, Ferrero E, Quaglino S, Rizza A, Maritati G, Portoghese M, Verzini F, Discalzi A, Pulli R, Fargion A, Bonvini S, Intrieri F, Speziale F, Mansour W, Moniaci D, Troisi N, Colli A, Camparini S, Genavi G, Pratesi G, Massi F, Michelagnoli S, Chisci E, Bonardelli S, Maione M, Angiletta D, Zacà S, Veraldi GF, Mezzetto L. A technical review of bail-out procedures to place Najuta stent-graft into the ascending aorta. CVIR Endovasc 2023; 6:7. [PMID: 36809454 PMCID: PMC9944130 DOI: 10.1186/s42155-023-00351-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/23/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND The Najuta stent-graft (Kawasumi Laboratories Inc., Tokyo, Japan) is usually easily advanced to the correct deployment position in the ascending aorta thanks to the pre-curved delivery J-sheath with all fenestrations automatically oriented towards the supra-aortic vessels. Aortic arch anatomy and delivery system stiffness could however represent limitations for proper endograft advancement, especially when the aortic arch bends sharply. The aim of this technical note is to report a series of bail-out procedures that could be useful to overcome the difficulties encountered during the Najuta stent-graft advancement up to the ascending aorta. MAIN BODY The insertion, positioning and deployment of a Najuta stent-graft requires a through-and-through guidewire technique using a .035″ 400 cm hydrophilic nitinol guidewire (Radifocus™ Guidewire M Non-Vascular, Terumo Corporation, Tokyo, Japan) with right brachial and both femoral accesses. When standard maneuver to put the endograft tip into the aortic arch, some bail-out procedures can be applied to obtain proper positioning. Five techniques are described into the text: positioning of a coaxial extra-stiff guidewire; positioning of a long introducer sheath down to the aortic root from the right brachial access; inflation of a balloon inside the ostia of the supra-aortic vessels; inflation of a balloon inside the aortic arch (coaxial to the device); and transapical access technique. This is a troubleshooting guide for allowing physicians to overcome various difficulties with the Najuta endograft as well as for other similar devices. SHORT CONCLUSION Technical issues in advancing the delivery system of Najuta stent-graft could occur. Therefore, the rescue procedures described in this technical note could be useful to guarantee the correct positioning and deployment of the stent-graft.
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Affiliation(s)
- Raffaella Berchiolli
- grid.5395.a0000 0004 1757 3729Vascular Surgery Unit, Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Cisanello Hospital, Via Roma 67, 56126 Pisa, Italy
| | - Nicola Troisi
- Vascular Surgery Unit, Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Cisanello Hospital, Via Roma 67, 56126, Pisa, Italy.
| | - Giulia Bertagna
- grid.5395.a0000 0004 1757 3729Vascular Surgery Unit, Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Cisanello Hospital, Via Roma 67, 56126 Pisa, Italy
| | - Andrea Colli
- grid.5395.a0000 0004 1757 3729Division of Cardiac Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | - Laura Besola
- grid.5395.a0000 0004 1757 3729Division of Cardiac Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | - Roberto Silingardi
- grid.7548.e0000000121697570Department of Vascular Surgery, University of Modena and Reggio Emilia, Nuovo Ospedale S. Agostino Estense, Modena, Italy
| | - Gioele Simonte
- grid.417287.f0000 0004 1760 3158Department of Vascular and Endovascular Surgery, University Hospital of Perugia, Perugia, Italy
| | - Giacomo Isernia
- grid.417287.f0000 0004 1760 3158Department of Vascular and Endovascular Surgery, University Hospital of Perugia, Perugia, Italy
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Mansour W, Capoccia L, Sirignano P, Di Girolamo A, Molinari A, Bozzao A, Taurino M, Di Marzo L. Carbon Dioxide Stent Flushing To Prevent Cerebral Air Microembolism During Carotid Artery Stenting: Protocol for a Randomised Study. EJVES Vasc Forum 2023. [DOI: 10.1016/j.ejvsvf.2023.02.008] [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: 04/08/2023] Open
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Capoccia L, Mansour W, Sirignano P, Porreca C, Dajci A, Galasan V, Di Marzo L. Venous Thrombo-Embolism in an Outpatient Vascular Ultrasound Laboratory All-Comers Cohort with Recent COVID-19 Infection. EJVES Vasc Forum 2022. [PMCID: PMC8940237 DOI: 10.1016/j.ejvsvf.2021.12.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sirignano P, Stabile E, Mansour W, Capoccia L, Taurino M, Speziale F. Twelve Months Results from a Prospective Real-World Multicenter Clinical Practice of Carotid Artery Stenting Using the CGuard Embolic Prevention System: The IRONGUARD 2 Study. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.06.351] [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: 11/28/2022]
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Sirignano P, Stabile E, Mansour W, Capoccia L, Faccenna F, Intrieri F, Ferri M, Saccà S, Sponza M, Mortola P, Ronchey S, Praquin B, Grillo P, Chiappa R, Losa S, Setacci F, Pirrelli S, Taurino M, Ruffino MA, Udini M, Palombo D, Ippoliti A, Montelione N, Setacci C, de Donato G, Ruggeri M, Speziale F. 1-Year Results From a Prospective Experience on CAS Using the CGuard Stent System: The IRONGUARD 2 Study. JACC Cardiovasc Interv 2021; 14:1917-1923. [PMID: 34391704 DOI: 10.1016/j.jcin.2021.05.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/10/2021] [Accepted: 05/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the 1-year safety and efficacy of a dual-layered stent (DLS) for carotid artery stenting (CAS) in a multicenter registry. BACKGROUND DLS have been proved to be safe and efficient during short-term follow-up. Recent data have raised the concern that the benefit of CAS performed with using a DLS may be hampered by a higher restenosis rate at 1 year. METHODS From January 2017 to June 2019, a physician-initiated, prospective, multispecialty registry enrolled 733 consecutive patients undergoing CAS using the CGuard embolic prevention system at 20 centers. The primary endpoint was the occurrence of death and stroke at 1 year. Secondary endpoints were 1-year rates of transient ischemic attack, acute myocardial infarction, internal carotid artery (ICA) restenosis, in-stent thrombosis, and external carotid artery occlusion. RESULTS At 1 year, follow-up was available in 726 patients (99.04%). Beyond 30 days postprocedure, 1 minor stroke (0.13%), four transient ischemic attacks (0.55%), 2 fatal acute myocardial infarctions (0.27%), and 6 noncardiac deaths (1.10%) occurred. On duplex ultrasound examination, ICA restenosis was found in 6 patients (0.82%): 2 total occlusions and 4 in-stent restenoses. No predictors of target ICA restenosis and/or occlusion could be detected, and dual-antiplatelet therapy duration (90 days vs 30 days) was not found to be related to major adverse cardiovascular event or restenosis occurrence. CONCLUSIONS This real-world registry suggests that DLS use in clinical practice is safe and associated with minimal occurrence of adverse neurologic events up to 12-month follow-up.
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Affiliation(s)
- Pasqualino Sirignano
- Vascular and Endovascular Surgery Unit, Department of Surgery, "Sapienza" University of Rome, Rome, Italy.
| | - Eugenio Stabile
- Division of Cardiology, Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Wassim Mansour
- Vascular and Endovascular Surgery Unit, Department of Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Laura Capoccia
- Vascular and Endovascular Surgery Unit, Department of Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Federico Faccenna
- Vascular and Endovascular Surgery Unit, Department of Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Francesco Intrieri
- Unit of Vascular and Endovascular Surgery, Annunziata Hospital, Cosenza, Italy
| | - Michelangelo Ferri
- Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy
| | - Salvatore Saccà
- Division of Cardiology, Mirano Public Hospital, Mirano, Italy
| | - Massimo Sponza
- Division of Vascular and Interventional Radiology, Udine University Hospital, Udine, Italy
| | - Paolo Mortola
- Department of Vascular and Endovascular Surgery, Galliera Hospital, Genoa, Italy
| | - Sonia Ronchey
- Unit of Vascular Surgery, Surgical Specialty Department, S. Filippo Neri Hospital, Rome, Italy
| | - Barbara Praquin
- Unit of Vascular Surgery, Surgical Specialty Department, S. Filippo Neri Hospital, Rome, Italy
| | - Placido Grillo
- Division of Cardiology, Sant. Anna Hospital, Catanzaro, Italy
| | - Roberto Chiappa
- Department of Vascular and Endovascular Surgery, Sandro Pertini Hospital, Rome, Italy
| | - Sergio Losa
- Cardiovascular Department, MultiMedica IRCCS Scientific Institute, Milan, Italy
| | - Francesco Setacci
- Cardiovascular Department, MultiMedica IRCCS Scientific Institute, Milan, Italy
| | - Stefano Pirrelli
- Division of Vascular Surgery, Carlo Poma Hospital, Mantova, Italy
| | - Maurizio Taurino
- Unit of Vascular Surgery, Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Maria Antonella Ruffino
- Department of Diagnostic Imaging and Radiotherapy - Vascular Radiology, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Marco Udini
- Vascular Surgery, Moriggia Pelascini Hospital, Gravedona, Como, Italy
| | - Domenico Palombo
- Vascular and Endovascular Surgery Unit, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Arnaldo Ippoliti
- Vascular Surgery Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Nunzio Montelione
- Vascular Surgery, University of Campus Biomedico of Rome, Rome, Italy
| | - Carlo Setacci
- Department of Medicine, Surgery and Neuroscience, Vascular and Endovascular Surgery, University of Siena, Siena, Italy
| | - Gianmarco de Donato
- Department of Medicine, Surgery and Neuroscience, Vascular and Endovascular Surgery, University of Siena, Siena, Italy
| | - Massimo Ruggeri
- Vascular Surgery, San Camillo de Lellis Hopital, Rieti, Italy
| | - Francesco Speziale
- Vascular and Endovascular Surgery Unit, Department of Surgery, "Sapienza" University of Rome, Rome, Italy
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Smith M, De Gale B, Mansour W. Cardiovascular risk of former obesity in healthy-weight Americans. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.646] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sirignano P, Silingardi R, Mansour W, Andreoli F, Migliari M, Speziale F. Unibody bifurcated aortic endograft: device description, review of the literature and future perspectives. Future Cardiol 2021; 17:793-804. [DOI: 10.2217/fca-2020-0119] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The unibody (Powerlink/AFX/AFX2) Endovascular AAA device (Endologix Inc., CA, USA) presents a unique design with its long main body and two innate limbs. The device is designed to be deployed and sits on the native aortoiliac bifurcation and represents the only one-piece bifurcated endograft designed to use anatomical fixation for endograft stabilization. According to published literature, the unibody device seems to represent a valid choice in the treatment of abdominal aortic aneurysms. This particular device would seem to satisfactorily perform even in the treatment of more compressed aneurysms (also in off-label association with parallel grafts) and in occlusive pathologies. Ongoing studies will provide new real-life data in a large and unselected patient population to better understand the device’s advantages and limitations.
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Affiliation(s)
- Pasqualino Sirignano
- Vascular & Endovascular Surgery Unit, Department of Surgery Paride Stefanini, Policlinico Umberto I of Rome, Sapienza University of Rome, Rome, Italy
| | - Roberto Silingardi
- Department of Vascular Surgery, Ospedale Civile Sant’Agostino-Estense, Azienda Ospedaliero-Universitaria di Modena, University of Modena & Reggio Emilia, Modena, Italy
| | - Wassim Mansour
- Vascular Surgery Unit, Department of Surgery Pietro Valdoni, Policlinico Umberto I of Rome, Sapienza University of Rome, Rome, Italy
| | - Francesco Andreoli
- Department of Vascular Surgery, Ospedale Civile Sant’Agostino-Estense, Azienda Ospedaliero-Universitaria di Modena, University of Modena & Reggio Emilia, Modena, Italy
| | - Mattia Migliari
- Department of Vascular Surgery, Ospedale Civile Sant’Agostino-Estense, Azienda Ospedaliero-Universitaria di Modena, University of Modena & Reggio Emilia, Modena, Italy
| | - Francesco Speziale
- Vascular & Endovascular Surgery Unit, Department of Surgery Paride Stefanini, Policlinico Umberto I of Rome, Sapienza University of Rome, Rome, Italy
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Fornelli F, Sirignano P, Mansour W, Capoccia L, Cuozzo S, Speziale F, Sbarigia E. Could Gender Impact on Immediate and Long-term Carotid Artery Stenting Outcome? Insight from an Italian Single Center Experience. Ann Vasc Surg 2021; 76:342-350. [PMID: 33951519 DOI: 10.1016/j.avsg.2021.04.014] [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: 02/12/2021] [Revised: 03/27/2021] [Accepted: 04/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Carotid artery stenting (CAS) has become a valid alternative to carotid endarterectomy in stroke prevention. However, female gender is still considered as an independent risk factor for CAS procedures, potentially limiting immediate and long-term benefits. Aim of present study was to evaluate gender differences in CAS submitted patients from an Italian high-volume center. MATERIAL AND METHODS a retrospective monocentric study has been conducted on 568 patients (366 males and 202 females), submitted to CAS, between January 2000 and December 2019. Besides gender sex, clinical anatomical, and procedural data were collected as possible factors determining the outcome, when associated to sex gender itself. Primary endpoint of this study consisted in evaluating the technical and procedural success ratio, and the incidence of major and minor stroke, transient ischemic attack, acute myocardial infarction (AMI) peri-procedurally and at medium and long term, between the male and the female population. Secondary endpoint of this study consisted in evaluating the percentage ratio of minor complications happening peri-procedurally in both genders. RESULTS Male patients were more likely to be octogenarians, clinical history of coronary artery disease, and smokers, while diabetes was more frequent in female patients. Anatomical and plaque morphology features were not different between the two groups. Technical success was obtained in all but two patients (99,6%), while procedural success was 95% (538/566 patients). During the peri-procedural time, no major stroke, 16 minor strokes (2,81%, 2,45% males vs. 3,45% females, P= 0,48), and 11 transient ischemic attack (2,18% males vs. 1,48% females, P= 0,56) were recorded. At a medium follow-up 57 months, 32 stroke (8 major strokes, 24 minor strokes) episodes (5,6%, males 5,7% vs. females 5,4%, P= 0,88), 24 AMIs (4,2%, males 4,6% vs. females 3,46%, P= 0,5;), 13 restenosis (2,8%, males 2,4% vs. females 1,9%, P= 0,71) and 223 deaths (39,2%, males 34,9% vs. females 47%, P= 0,0048) were noted. CONCLUSIONS Our results showed no differences in immediate, and long-term CAS outcomes between gender. Larger, prospective studies are required to assess the real importance and significance of gender in determining CAS procedures' benefit and outcome.
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Affiliation(s)
- Federica Fornelli
- Vascular and Endovascular Surgery Unit, Department of Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Pasqualino Sirignano
- Vascular and Endovascular Surgery Unit, Department of Surgery, "Sapienza" University of Rome, Rome, Italy.
| | - Wassim Mansour
- Vascular and Endovascular Surgery Unit, Department of Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Laura Capoccia
- Vascular and Endovascular Surgery Unit, Department of Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Simone Cuozzo
- Vascular and Endovascular Surgery Unit, Department of Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Francesco Speziale
- Vascular and Endovascular Surgery Unit, Department of Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Enrico Sbarigia
- Vascular and Endovascular Surgery Unit, Department of Surgery, "Sapienza" University of Rome, Rome, Italy
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Sirignano P, Mansour W, Capoccia L, Cuozzo S, Camparini S, de Donato G, Mangialardi N, Ronchey S, Talarico F, Setacci C, Speziale F. Endovascular aortic repair in patients with challenging anatomies: the EXTREME study. EUROINTERVENTION 2021; 16:e1544-e1550. [PMID: 31793884 PMCID: PMC9725024 DOI: 10.4244/eij-d-19-00547] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to report the 30-day technical and clinical success with endovascular repair using the ultra-low-profile Ovation stent graft in patients judged to be outside the instructions for use (IFU) for conventional endografts, while amenable to treatment within the IFU for Ovation. METHODS AND RESULTS One hundred and twenty-two patients (78.65±7.67 years; 111 male) were enrolled. Patients were evaluated as being outside the IFU for standard endografts because of the absence of a suitable proximal aortic neck in 109 cases (89.3%), of inadequate access vessels in 13 (10.7%), or both in 111 (90.9%). Mean aneurysm (abdominal aortic aneurysm [AAA]) diameter was 52.96±10.1 mm; mean aortic neck length was 7.75±6.05 mm. Technical success (98.4%) was achieved in all but two patients due to a type Ia endoleak. At completion angiography, 15 (12.3%) patients presented a type II endoleak. All patients underwent 30-day follow-up. Primary clinical success at one month was 96.8%, assisted clinical success 98.4%. There were no type I endoleaks, while 12 (9.8%) type II endoleaks were still evident, in the absence of sac expansions. Two patients (1.6%) presented an asymptomatic limb occlusion. CONCLUSIONS Our experience suggests that, in a selected population of patients with challenging anatomy outside the IFU for conventional endografts, endovascular aneurysm repair (EVAR) using the Ovation stent graft can be performed safely with satisfactory immediate outcomes.
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Affiliation(s)
- Pasqualino Sirignano
- Vascular and Endovascular Surgery Division, Policlinico Umberto I, Viale del Policlinico, 155, 00161 Rome, Italy
| | - Wassim Mansour
- Vascular and Endovascular Surgery Unit, Department of Surgery “Paride Stefanini”, Policlinico Umberto I of Rome, “Sapienza” University of Rome, Rome, Italy
| | - Laura Capoccia
- Vascular and Endovascular Surgery Unit, Department of Surgery “Paride Stefanini”, Policlinico Umberto I of Rome, “Sapienza” University of Rome, Rome, Italy
| | - Simone Cuozzo
- Vascular and Endovascular Surgery Unit, Department of Surgery “Paride Stefanini”, Policlinico Umberto I of Rome, “Sapienza” University of Rome, Rome, Italy
| | - Stefano Camparini
- Vascular and Endovascular Surgery Unit, Department of Thoraco-Vascular Surgery, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Gianmarco de Donato
- Vascular and Endovascular Surgery Unit, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
| | - Nicola Mangialardi
- Department of Vascular Surgery, “San Camillo Forlanini” Hospital, Rome, Italy
| | - Sonia Ronchey
- Department of Vascular Surgery, “San Filippo Neri” Hospital, Rome, Italy
| | - Francesco Talarico
- Division of Vascular and Endovascular Surgery, Ospedale Civico, Palermo, Italy
| | - Carlo Setacci
- Vascular and Endovascular Surgery Unit, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
| | - Francesco Speziale
- Vascular and Endovascular Surgery Unit, Department of Surgery “Paride Stefanini”, Policlinico Umberto I of Rome, “Sapienza” University of Rome, Rome, Italy
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Mansour W, Sirignano P, Capoccia L, di Marzo L. More inside stenting in aortic coarctation: The sequential stent dilation. Int J Cardiol 2021; 332:67-68. [PMID: 33689761 DOI: 10.1016/j.ijcard.2021.03.008] [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] [Received: 02/15/2021] [Accepted: 03/03/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Wassim Mansour
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza", University of Rome, Viale del Policlinico, 155 00161 Rome, Italy; Department of Surgery "Pietro Valdoni", Policlinico Umberto I, "Sapienza", University of Rome, Viale del Policlinico, 155 00161 Rome, Italy.
| | - Pasqualino Sirignano
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza", University of Rome, Viale del Policlinico, 155 00161 Rome, Italy.
| | - Laura Capoccia
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza", University of Rome, Viale del Policlinico, 155 00161 Rome, Italy.
| | - Luca di Marzo
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza", University of Rome, Viale del Policlinico, 155 00161 Rome, Italy.
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Montelione N, Sirignano P, d'Adamo A, Stilo F, Mansour W, Capoccia L, Nenna A, Spinelli F, Speziale F. Comparison of Outcomes Following EVAR Based on Aneurysm Diameter and Volume and Their Postoperative Variations. Ann Vasc Surg 2021; 74:183-193. [PMID: 33549787 DOI: 10.1016/j.avsg.2020.12.048] [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] [Received: 11/14/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE to evaluate the impact of bi- and 3-dimensional preoperative aortic morphological features and their immediate postoperative variations on the outcome of abdominal aortic aneurysms (AAA) treated by endovascular exclusion with standard devices (EVAR). MATERIALS AND METHODS Double centre retrospective analysis of prospectively collected registry data of EVAR patients. For all patients, preoperative and 30-day computed tomographic angiography images (CTA) were reviewed. Preoperative maximum AAA diameter >59 mm and volume >159 cm3, and any 30-day postoperative increasing at CTA, were considered as potentially influencing the outcome. The outcome measures were: primary technical success; 30-day, 1-year, and mean follow-up reintervention, all-cause and AAA-related mortality rates, and also endoleak-related reinterventions. RESULTS Three hundred and thrity-three patients were enrolled. Mean preoperative and 30-day AAA diameter and volume were 50.4 mm ± 11.8 vs. 49.1 mm ± 12.1, and 112.9 cm3 ± 79.5 vs. 112.1 cm3 ± 80.5, respectively. Primary technical success was achieved in all cases. At 34.9 months follow-up, cumulative reintervention rate was 12.0%, mortality rates 7.2%, without AAA-related deaths. Endoleak-related reintervention rate was 7.5%. At uni- and multi-variate analysis, preoperative AAA diameter >59 mm, and AAA volume >159 cm3 were significantly associated to reintervention (P = 0.012; P = 0.002), and reintervention and death (P = 0.002; P = 0.001) during follow-up. Additionally, any increase in postoperative AAA diameter or volume was significantly associated with reintervention (P = 0.001, P = 0.001) and reintervention and death (P = 0.006, P = 0.001). Endoleak-related reintervention were also significantly associated with all of the analysed morphological parameters (P = 0.019, P = 0.005, P = 0.005, and P = 0.002, respectively). CONCLUSIONS Patients with larger baseline AAA size and volume as well as unfavourable early remodelling of the sac are associated to worse long-term EVAR outcome.
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Affiliation(s)
- Nunzio Montelione
- Vascular Surgery Division, University of Campus Bio-Medico, Rome, Italy.
| | - Pasqualino Sirignano
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Italy
| | - Alessandro d'Adamo
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Italy
| | - Francesco Stilo
- Vascular Surgery Division, University of Campus Bio-Medico, Rome, Italy
| | - Wassim Mansour
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Italy
| | - Laura Capoccia
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Italy
| | - Antonio Nenna
- Department of Cardiovascular Surgery, University of Campus Bio-Medico, Rome, Italy
| | | | - Francesco Speziale
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Italy
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Sirignano P, Stabile E, Stabile E, Mansour W, Mansour W, Speziale F, Speziale F. One-month results from a prospective experience on CAS using C-GUARD stent system: the IRONGUARD-2 study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2692] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
To evaluate 30-day safety and efficacy of dual layered mesh covered carotid stent systems (DLS) for carotid artery stenting (CAS) in the clinical practice.
Background
When compared to carotid endarterectomy CAS has been associated to an higher rate of post procedural neurologic events; these could be related to plaque's debris prolapsing through stent's mesh. Consequently, the need for increased plaque coverage has resulted in the development of DLS.
Methods
From January 2017 to June 2019 a physician-initiated, prospective, multispecialty, registry enrolled 733 consecutive patients undergoing CAS using the CGuard Embolic Prevention System (EPS) in 20 centres. Primary endpoint was the stroke up to 30 days; secondary endpoints were the technical and procedural success; external carotid artery (ECA) occlusion; in-hospital and 30 days transient ischemic attack (TIA), acute myocardial infarction (AMI) and death rates.
Results
Symptoms were present in 131 patients (17.87%). An embolic protection device (EPD) was used in 731 patients (99.72%). Procedural success was 100%, technical success was obtained in all but one patient (99.86%), who died in-hospital due to a haemorrhagic stroke. Six TIAs, 2 minor strokes, and 1 AMI occurred during in-hospital stay, ECA occlusion was evident in 8 patients (1.09%). Between hospital discharge and 30-day, 2 TIAs, 1 minor stroke and 3 AMIs occurred. Therefore, the stroke rate at 30 days was 0.13.
Conclusion
This real-world registry suggests that use of CGuard EPS in clinical practice is safe and associated to a minimal occurrence of adverse neurological events up to 30 days follow up.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - E Stabile
- Federico II University of Naples, Naples, Italy
| | - E Stabile
- Federico II University of Naples, Naples, Italy
| | - W Mansour
- Sapienza University of Rome, Rome, Italy
| | - W Mansour
- Sapienza University of Rome, Rome, Italy
| | - F Speziale
- Sapienza University of Rome, Rome, Italy
| | - F Speziale
- Sapienza University of Rome, Rome, Italy
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Stabile E, De Donato G, Musialek P, Deloose K, Nerla R, Sirignano P, Mazurek A, Mansour W, Fioretti V, Esposito F, Chianese S, Bosiers M, Speziale F, Micari A, Esposito G. Use of dual layered stents in endovascular treatment of extracranial stenosis of the internal carotid artery: one year results of a patient-based meta-analysis of 4 clinical studies. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2405] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Small sized clinical studies evaluating one year outcomes of CAS performed with two available DLS, Roadsaver® (RS) and CGuard® (CG), have been published.
Purpose
To evaluate one year safety and efficacy of dual layered mesh covered carotid stent systems (DLS) for carotid artery stenting (CAS).
Methods
We performed an individual patient-level meta-analysis including studies enrolling more than 100 CAS with DLS. Primary endpoint was the death and stroke rate; secondary endpoints were restenosis and in-stent thrombosis rates at one year.
Results
Patients were divided in two groups according to DLS (RS N=250; CG N=306). At one year, 11 patients died (1.97%), 7 patients in the group RS (2.8%) and 4 patients in the CG one (1.31%), 10 strokes occurred, 4 in the group RS (1.6%) and 6 in the CG one (1.96%). Overall death and stroke rate was 3.77% (N=21), 11 events in the group RS (4.4%) and 10 in the CG group (3.27%). Symptomatic status was the only predictor of death and or stroke.
At one year restenosis occurred in 12 patients (2.1%), 10 in the group RS (4%) and 2 in the CG one (0.65%) (p=0.007). In stent thrombosis occurred in 1 patient (0.18%) of the group CG (0.32%). RS use was the only independent restenosis predictor.
Conclusions
This study suggests that DLS use for CAS is associated to a low one year death and stroke rate and specific DLS stent use could affect restenosis rate.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- E Stabile
- Federico II University of Naples, Naples, Italy
| | | | | | - K Deloose
- St Blasius Hospital, Dendermonde, Belgium
| | - R Nerla
- Clinical Institute Humanitas Gavazzeni, Bergamo, Italy
| | | | - A Mazurek
- Jagiellonian University, Krakow, Poland
| | - W Mansour
- Sapienza University of Rome, Rome, Italy
| | - V Fioretti
- Federico II University of Naples, Naples, Italy
| | - F Esposito
- Federico II University of Naples, Naples, Italy
| | - S Chianese
- Federico II University of Naples, Naples, Italy
| | - M Bosiers
- St Blasius Hospital, Dendermonde, Belgium
| | - F Speziale
- Sapienza University of Rome, Rome, Italy
| | - A Micari
- Clinical Institute Humanitas Gavazzeni, Bergamo, Italy
| | - G Esposito
- Federico II University of Naples, Naples, Italy
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Faccenna F, Sirignano P, Mansour W, Speziale F. Painful Thigh Hematoma Following Intravascular Lithotripsy for Severe Calcified Superficial Femoral Artery Lesion. Cardiovasc Intervent Radiol 2020; 44:342-344. [PMID: 33083855 DOI: 10.1007/s00270-020-02665-5] [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] [Received: 08/31/2020] [Accepted: 09/19/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Federico Faccenna
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", "Sapienza" University of Rome, Policlinico Umberto I, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Pasqualino Sirignano
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", "Sapienza" University of Rome, Policlinico Umberto I, Viale del Policlinico, 155, 00161, Rome, Italy.
| | - Wassim Mansour
- Vascular Surgery Unit, Department of Surgery "P. Valdoni", Policlinico "Umberto I", "Sapienza" University of Rome, Rome, Italy
| | - Francesco Speziale
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", "Sapienza" University of Rome, Policlinico Umberto I, Viale del Policlinico, 155, 00161, Rome, Italy
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Sirignano P, Stabile E, Mansour W, Capoccia L, Faccenna F, Intrieri F, Ferri M, Saccà S, Sponza M, Mortola P, Ronchey S, Grillo P, Chiappa R, Losa S, Setacci F, Pirrelli S, Taurino M, Ruffino MA, Udini M, Palombo D, Ippoliti A, Montelione N, Setacci C, de Donato G, Ruggeri M, Speziale F. 1-Month Results From a Prospective Experience on CAS Using CGuard Stent System. JACC Cardiovasc Interv 2020; 13:2170-2177. [DOI: 10.1016/j.jcin.2020.05.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 12/26/2022]
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Stabile E, de Donato G, Musialek P, Deloose K, Nerla R, Sirignano P, Mazurek A, Mansour W, Fioretti V, Esposito F, Chianese S, Bosiers M, Setacci C, Speziale F, Micari A, Esposito G. Use of Dual-Layered Stents for Carotid Artery Angioplasty. JACC Cardiovasc Interv 2020; 13:1709-1715. [DOI: 10.1016/j.jcin.2020.03.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/11/2020] [Accepted: 03/31/2020] [Indexed: 12/24/2022]
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Silingardi R, Sirignano P, Andreoli F, Mansour W, Migliari M, Speziale F. Correction: Unibody Endograft Using AFX 2 for Less Invasive and Faster Endovascular Aortic Repair: Protocol for a Multicenter Nonrandomized Study. JMIR Res Protoc 2020; 9:e20698. [PMID: 32579539 PMCID: PMC7381068 DOI: 10.2196/20698] [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: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Roberto Silingardi
- Department of Vascular Surgery, Ospedale Civile Sant'Agostino-Estense, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Pasqualino Sirignano
- Vascular and Endovascular Surgery Unit, Department of Surgery Paride Stefanini, Sapienza University of Rome, Rome, Italy
| | - Francesco Andreoli
- Department of Vascular Surgery, Ospedale Civile Sant'Agostino-Estense, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Wassim Mansour
- Vascular and Endovascular Surgery Unit, Department of Surgery Paride Stefanini, Sapienza University of Rome, Rome, Italy
| | - Mattia Migliari
- Department of Vascular Surgery, Ospedale Civile Sant'Agostino-Estense, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Speziale
- Vascular and Endovascular Surgery Unit, Department of Surgery Paride Stefanini, Sapienza University of Rome, Rome, Italy
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- See Acknowledgments section for collaborators/group members,
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Silingardi R, Sirignano P, Andreoli F, Mansour W, Migliari M, Speziale F. Unibody Endograft Using AFX 2 for Less Invasive and Faster Endovascular Aortic Repair: Protocol for a Multicenter Nonrandomized Study. JMIR Res Protoc 2020; 9:e16959. [PMID: 32250278 PMCID: PMC7171559 DOI: 10.2196/16959] [Citation(s) in RCA: 7] [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] [Received: 11/07/2019] [Revised: 01/20/2020] [Accepted: 01/26/2020] [Indexed: 01/20/2023] Open
Abstract
Background Since the introduction of endovascular aortic repair (EVAR) for treatment of abdominal aortic aneurysms (AAAs), progressive improvements in results have been achieved. However, conventional bifurcated stent grafts have been proven to have a nonnegligible risk of failure and secondary intervention, principally due to the lack of adequate proximal sealing. The unique AFX 2 Endovascular AAA System (Endologix, Irvine, CA) unibody device, which provides different sealing and fixation features compared with conventional devices, seems to overcome these limitations. Objective The aim of this study is to evaluate intraoperative, perioperative, and postoperative results in patients treated with the AFX 2 Endovascular AAA System endografts for elective AAA repair in a large cohort of consecutive patients. Methods All eligible EVAR patients will be included in this observational, multicenter, prospective, nonrandomized study. The number of patients to be enrolled is 500. Results The primary endpoint of the study is to evaluate the technical and clinical success of EVAR with unibody endografts in short- (90-day), mid- (1-year), and long-term (5-year) follow-up periods. The following secondary endpoints will also be addressed: operative time, intraoperative radiation exposure, contrast medium usage, AAA sac shrinkage at 12-month and 5-year follow-up, and any potential role of patients’ baseline characteristics and device configuration on primary endpoint. The actual start date of the investigation was November 2019. The final patient is expected to be treated by the end of December 2020, and the estimated study completion date is December 2025. Conclusions This study will provide verified real-world data on AAAs treated by AFX 2 endografts and followed for a long-term interval. International Registered Report Identifier (IRRID) PRR1-10.2196/16959
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Affiliation(s)
- Roberto Silingardi
- Department of Vascular Surgery, Ospedale Civile Sant'Agostino-Estense, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Pasqualino Sirignano
- Vascular and Endovascular Surgery Unit, Department of Surgery Paride Stefanini, Sapienza University of Rome, Rome, Italy
| | - Francesco Andreoli
- Department of Vascular Surgery, Ospedale Civile Sant'Agostino-Estense, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Wassim Mansour
- Vascular and Endovascular Surgery Unit, Department of Surgery Paride Stefanini, Sapienza University of Rome, Rome, Italy
| | - Mattia Migliari
- Department of Vascular Surgery, Ospedale Civile Sant'Agostino-Estense, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Speziale
- Vascular and Endovascular Surgery Unit, Department of Surgery Paride Stefanini, Sapienza University of Rome, Rome, Italy
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- See Acknowledgments section for collaborators/group members
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Sirignano P, Mansour W, Baldassarre V, Porreca CF, Cuozzo S, Miceli F, Capoccia L, Sbarigia E, Speziale F. Infrarenal Abdominal Aortic Aneurysm Endovascular Treatment: Long-term Results From a Single-Center Experience in an Unselected Patient Population. Ann Vasc Surg 2020; 67:274-282. [PMID: 32209404 DOI: 10.1016/j.avsg.2020.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate early-, mid-, and long-term outcomes in an unselected population of patients treated for abdominal aortic aneurysms (AAAs) by endovascular aneurysm repair (EVAR) with different commercially available off-the-shelf devices. MATERIALS AND METHODS A retrospective study was conducted on a prospectively compiled computerized database on patients presenting an infrarenal AAA treated between January 2008 and December 2015 in a high-volume Italian tertiary referral Center. Demographic, clinical, and specific morphological features were considered as potentially influencing the outcomes and the type of the implanted device. Outcome measures were procedure-related reintervention, AAA-related, and all-cause mortality rates at 30-day, 12-month, and long-term follow-up. Reinterventions considered for the analysis were AAA rupture, graft infection, type I or III endoleaks, type II endoleaks with sac enlargement > 5 mm, graft stenosis or occlusions, procedures related to renal or visceral ischemia, and reintervention for access vessel injury. RESULTS Of 498 EVAR procedures performed for elective infrarenal AAA treatment during the entire study period, 479 patients were enrolled, the mean age was 73.5 ± 7.34 years (range 51-91), and 416 (86.84%) were men. The mean maximum AAA diameter was 52.02 ± 8.04 mm (range 39-90.2), a maximum AAA diameter ≥59 mm was recorded in 107 patients (22.33%), and an aortic neck length was <10 mm in 137 (28.60%). Technical success was achieved in all patients. At a mean follow-up of 52.97 ± 26.16 months (range 1-120), overall reintervention and death rates were 8.14% and 20.04%, respectively, without AAA-related deaths. At univariate analysis, hypertension was the only demographical variable found to be associated with higher risk of reintervention, P = 0.04 (OR: 2.34; CI 95%: 1.00-5.42). Furthermore, male sex (P = 0.02; OR: 2.62; CI 95%: 1.09-6.27) and chronic renal insufficiency (P = 0.003; OR: 2.08; CI 95%: 1.27-3.42) were associated with higher mortality rates. AAA diameter ≥59 mm was statistically associated with a higher rate of both reintervention and mortality: P < 0.001 (OR: 9.05; CI 95%: 4.52-18.11) and <0.001 (4.00; 2.46-6.49), respectively. CONCLUSIONS Our experience seems to suggest that EVAR could be safely and effectively performed in an unselected patients' population, with encouraging results up to a ten-year follow-up.
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Affiliation(s)
- Pasqualino Sirignano
- Vascular and Endovascular Surgery Unit, Department of Surgery "Paride Stefanini", Policlinico Umberto I of Rome, "Sapienza" University of Rome, Rome, Italy.
| | - Wassim Mansour
- Vascular and Endovascular Surgery Unit, Department of Surgery "Paride Stefanini", Policlinico Umberto I of Rome, "Sapienza" University of Rome, Rome, Italy
| | - Virgilio Baldassarre
- Vascular and Endovascular Surgery Unit, Department of Surgery "Paride Stefanini", Policlinico Umberto I of Rome, "Sapienza" University of Rome, Rome, Italy
| | - Carlo Filippo Porreca
- Vascular and Endovascular Surgery Unit, Department of Surgery "Paride Stefanini", Policlinico Umberto I of Rome, "Sapienza" University of Rome, Rome, Italy
| | - Simone Cuozzo
- Vascular and Endovascular Surgery Unit, Department of Surgery "Paride Stefanini", Policlinico Umberto I of Rome, "Sapienza" University of Rome, Rome, Italy
| | - Francesca Miceli
- Vascular and Endovascular Surgery Unit, Department of Surgery "Paride Stefanini", Policlinico Umberto I of Rome, "Sapienza" University of Rome, Rome, Italy
| | - Laura Capoccia
- Vascular and Endovascular Surgery Unit, Department of Surgery "Paride Stefanini", Policlinico Umberto I of Rome, "Sapienza" University of Rome, Rome, Italy
| | - Enrico Sbarigia
- Vascular and Endovascular Surgery Unit, Department of Surgery "Paride Stefanini", Policlinico Umberto I of Rome, "Sapienza" University of Rome, Rome, Italy
| | - Francesco Speziale
- Vascular and Endovascular Surgery Unit, Department of Surgery "Paride Stefanini", Policlinico Umberto I of Rome, "Sapienza" University of Rome, Rome, Italy
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Mansour W, Sirignano P, Capoccia L, Fornelli F, Speziale F. Urgent Mechanical Thrombectomy by Indigo System® in Acute Thrombosed Popliteal Artery Aneurysms: A Report of Two Cases. Ann Vasc Surg 2020; 63:458.e1-458.e6. [DOI: 10.1016/j.avsg.2019.08.100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 12/23/2022]
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Mansour W, Sirignano P, d’Adamo A, Cuozzo S, Speziale F. AAA 19. Midterm Results of Parallel Grafts in Patients With Pararenal and Type IV Thoracoabdominal Aortic Aneurysms Unsuitable for Fenestrated or Branched Endografts. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.08.075] [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: 11/29/2022]
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Sirignano P, Mansour W, Capoccia L, Intrieri F, Ferri M, Saccà S, Sponza M, Mortola P, Stabile E, Speziale F. CAR 8. Preliminary Results From a Prospective Real-World Multicenter Clinical Practice of Carotid Artery Stenting Using the CGuard Embolic Prevention System: The IRONGUARD 2 Study. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.08.129] [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: 11/29/2022]
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Mansour W, Sirignano P, Capoccia L, Speziale F. Pressure injury to the chest wall caused by vascular graft and endograft after thoracic and thoraco-abdominal aortic repair. Interact Cardiovasc Thorac Surg 2019; 29:649-651. [PMID: 31180511 DOI: 10.1093/icvts/ivz127] [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: 01/30/2019] [Revised: 04/23/2019] [Accepted: 04/26/2019] [Indexed: 02/04/2023] Open
Abstract
Thoracic and thoraco-abdominal aortic repair remains a challenging issue in vascular surgery, and long-term complications are well described. We report 2 cases of octogenarians with unusual long-term complications after open and endovascular thoracic aortic repair of chest wall pressure injury from the vascular prosthesis. In the first case, a computed tomographic scan of an 80-year-old man showed a pressure injury of the chest wall and rib erosion caused by a Dacron graft. The second case was an 81-year-old woman who presented with external bleeding from the left posterior chest wall. A computed tomographic scan showed a type IA endoleak and chest wall damage with rib erosion and thoracic cutaneous fistulae from the endovascular graft. Both patients were treated by relining the endovascular graft; debriding the surgical fistula was done only in the second case. In our experience, endovascular repair is a good option to avoid a complete open surgical repair.
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Affiliation(s)
- Wassim Mansour
- Department of Surgery "P. Stefanini", Vascular and Endovascular Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Pasqualino Sirignano
- Department of Surgery "P. Stefanini", Vascular and Endovascular Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Laura Capoccia
- Department of Surgery "P. Stefanini", Vascular and Endovascular Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Francesco Speziale
- Department of Surgery "P. Stefanini", Vascular and Endovascular Surgery, "Sapienza" University of Rome, Rome, Italy
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Brunoro M, Baldassarre V, Sirignano P, Mansour W, Capoccia L, Speziale F. Endovascular Treatment of an Anterior Tibial Artery Pseudoaneurysm Secondary to Penetrating Trauma in a Young Patient: Case Report and Literature Review. Ann Vasc Surg 2019; 60:479.e5-479.e9. [PMID: 31195105 DOI: 10.1016/j.avsg.2019.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/11/2019] [Accepted: 03/11/2019] [Indexed: 10/26/2022]
Abstract
We report a case of an 18-year-old woman who developed a delayed pseudoaneurysm of the right anterior tibial artery (ATA), 14 days after a knife accidental trauma. The patient was admitted to our emergency department for acute onset of pain in the right limb after a domestic trauma. At a physical examination, the limb was tense and tender, with a pulsatile mass in the anterior compartment. Femoral, popliteal, and distal pulses were palpable on both limbs. Duplex ultrasound scan (DUS) and computed tomography angiography showed the presence of an ATA pseudoaneurysm. An urgent endovascular treatment was performed under local anesthesia via percutaneous access. Pseudoaneurysm was excluded implanting 2 coronary covered balloon-expandable stents (BeGraft; Bentley Innomed GmbH, Hechingen, Germany). Postoperative course was uneventful and the patient was discharged on the second postoperative day under dual antiplatelet therapy. One- and 13-month scheduled follow-up visits and DUS revealed the presence of a normal pedal pulse, complete pseudoaneurysm exclusion, and patency of the stent grafts and the entire ATA with triphasic waveforms. In conclusion, endovascular treatment of an ATA pseudoaneurysm seems to be a feasible option. Further experience with this technique is needed to validate its safety and long-term patency, especially in young and healthy subjects.
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Affiliation(s)
- Matteo Brunoro
- Vascular and Endovascular Surgery Unit, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
| | - Virgilio Baldassarre
- Vascular and Endovascular Surgery Unit, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Pasqualino Sirignano
- Vascular and Endovascular Surgery Unit, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Wassim Mansour
- Vascular and Endovascular Surgery Unit, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Laura Capoccia
- Vascular and Endovascular Surgery Unit, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Francesco Speziale
- Vascular and Endovascular Surgery Unit, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
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Capoccia L, Sirignano P, Mansour W, Formiconi M, d'Adamo A, Brunoro M, Sbarigia E, Speziale F. IP015. Long-Term Survival and Quality of Life in Infected Aortic Endograft With or Without Visceral Involvement. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.04.133] [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: 11/25/2022]
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Speziale F, Capoccia L, Sirignano P, Mansour W, Pranteda C, Casana R, Setacci C, Accrocca F, Alberti D, de Donato G, Ferri M, Gaggiano A, Galzerano G, Ippoliti A, Mangialardi N, Pratesi G, Ronchey S, Ruffino M, Siani A, Spinazzola A, Sponza M. Thirty-day results from prospective multi-specialty evaluation of carotid artery stenting using the CGuard MicroNet-covered Embolic Prevention System in real-world multicentre clinical practice: the IRON-Guard study. EUROINTERVENTION 2019; 13:1714-1720. [PMID: 28485278 DOI: 10.4244/eij-d-17-00008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of the present study was to evaluate periprocedural and 30-day outcomes in a prospective series of patients treated with the CGuard Embolic Prevention System (EPS). METHODS AND RESULTS From April 2015 to June 2016, a physician-initiated prospective multicentre study was performed in 200 consecutive patients admitted for protected carotid artery stenting (CAS) and treated using the CGuard EPS in twelve vascular centres. Outcome measures were: technical success, periprocedural (0-24 hours) and post-procedural (24 hours-30 days) major and minor strokes, death, acute myocardial infarction (AMI), transient ischaemic attack (TIA), and external carotid occlusion. In three centres, consecutive diffusion-weighted magnetic resonance cerebral imaging (DW-MRI) was performed ≤72 hours prior to and within 72 hours after the intervention. A distal embolic protection device was employed in 182 patients (91%). Technical success was 100%. No death, AMI or major stroke occurred periprocedurally. There were two TIAs and five periprocedural minor strokes (2.5%), including one thrombosis solved by surgery. In the remaining patients (199/200; 99.5%) one-month follow-up duplex ultrasound revealed optimal technical results. Post-procedural clinical follow-up was uneventful. No external carotid artery occlusion occurred. New post-procedural DW-MRI lesions were detected in 12 patients out of 61 (19.6%), including bilateral in five (8.2%) and isolated ipsilateral in six (9.8%), whereas one patient (1.6%) had contralateral only lesions. CONCLUSIONS Multicentre multi-specialty use of the CGuard EPS in routine clinical practice was associated with no major periprocedural neurologic complications and a total elimination of post-procedural neurologic complications by 30 days.
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Affiliation(s)
- Francesco Speziale
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
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Köcher S, Beyer B, Lange T, Nordquist L, Burdak-Rothkamm S, Schlomm T, Petersen C, Rothkamm K, Mansour W. OC-0635 Targeting TEMPRSS2:ERG fusion to achieve a tumor-specific radiosensitization in prostate cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31055-2] [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: 11/17/2022]
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Capoccia L, Sirignano P, Mansour W, d'Adamo A, Sbarigia E, Mariani P, Di Biasi C, Speziale F. Peri-procedural brain lesions prevention in CAS (3PCAS): Randomized trial comparing CGuard™ stent vs. Wallstent™. Int J Cardiol 2019; 279:148-153. [DOI: 10.1016/j.ijcard.2018.09.066] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 08/17/2018] [Accepted: 09/19/2018] [Indexed: 11/16/2022]
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Sirignano P, Capoccia L, Mansour W, Ronchey S, Accrocca F, Siani A, Mangialardi N, Speziale F. Type 2 Endoleak Incidence and Fate After Endovascular Aneurysms Repair in a Multicentric Series: Different Results with Different Devices? Ann Vasc Surg 2018; 56:224-232. [PMID: 30502380 DOI: 10.1016/j.avsg.2018.09.009] [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: 06/12/2018] [Revised: 08/31/2018] [Accepted: 09/01/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this work is describing incidence and fate of type 2 endoleaks (T2ELs) in a multicentric cohort of patients treated by endovascular aneurysms repair using the Ovation device (Endologix) and comparing them with a group treated using the Excluder (W. L. Gore & Associates). METHODS This is a retrospective study conducted on 261 patients treated using the Ovation device and 203 using the Excluder. Outcomes were intraprocedural, 30-day, 12-month, and mean time follow-up T2EL incidence and related reinterventions. Patent inferior mesenteric artery (IMA), ≥3 lumbar arteries (LAs), intrasac thrombus volume, the mean diameter of common and external iliac arteries, external iliac artery stenosis (>70%), diameter ≤5 mm, iliac tortuosity ratio ≤0.5, thrombosis, and calcification were noted and considered as potentially influencing outcomes. RESULTS Patients of the Ovation group presented significantly more thrombosed, calcified, and tortuous iliac vessels than those in the Excluder group. No significant differences were noted in sac thrombosis, IMA, and LA patency. At completion angiography, T2EL was evident in 57 Ovation and 46 Excluder patients (P = 0.832). At 1 month, it was evident in 33 Ovation group and 28 Excluder group patients (P = 0.726). At 12-month and mean time (30.14 months) follow-up, no differences were evident between the 2 groups (P = 0.940 and 0.951, respectively). The log-rank test showed that the rate of T2EL-related reintervention was not different between the 2 groups (P = 0.46). Regarding anatomical characteristics, a statistically significant difference was not observed between patients presenting or not with T2EL (P > 0.05). CONCLUSIONS Data showed no significant differences in terms of T2EL incidence between the 2 study groups. None of preoperative anatomical features were found to be significantly associated with the appearance of T2EL.
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Affiliation(s)
- Pasqualino Sirignano
- Vascular and Endovascular Surgery Unit, Department of Surgery "P Stefanini", Policlinico "Umberto I", "Sapienza" University of Rome, Rome, Italy.
| | - Laura Capoccia
- Vascular and Endovascular Surgery Unit, Department of Surgery "P Stefanini", Policlinico "Umberto I", "Sapienza" University of Rome, Rome, Italy
| | - Wassim Mansour
- Vascular and Endovascular Surgery Unit, Department of Surgery "P Stefanini", Policlinico "Umberto I", "Sapienza" University of Rome, Rome, Italy
| | - Sonia Ronchey
- Vascular and Endovascular Surgery Unit, San Filippo Neri Hospital, Rome, Italy
| | - Federico Accrocca
- Vascular and Endovascular Surgery Unit, Sant'Eugenio Hospital, Rome, Italy
| | - Andrea Siani
- Vascular and Endovascular Surgery Unit, Sant'Eugenio Hospital, Rome, Italy
| | - Nicola Mangialardi
- Vascular and Endovascular Surgery Unit, San Filippo Neri Hospital, Rome, Italy
| | - Francesco Speziale
- Vascular and Endovascular Surgery Unit, Department of Surgery "P Stefanini", Policlinico "Umberto I", "Sapienza" University of Rome, Rome, Italy
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Capoccia L, Sirignano P, Mansour W, Sbarigia E, Speziale F. Twelve-month results of the Italian registry on protected CAS with the mesh-covered CGuard stent: the IRON-Guard study. EUROINTERVENTION 2018; 14:1150-1152. [DOI: 10.4244/eij-d-18-00241] [Citation(s) in RCA: 12] [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] [Indexed: 11/23/2022]
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Mansour W, Baldassarre V, Sirignano P, Capoccia L, Cuozzo S, Speziale F. Unexpected Complication of a Nitinol-Constrained Balloon Angioplasty (Chocolate) in Rutherford Class 3 Patient Presenting Challenging Aorto-Iliac Anatomy. Ann Vasc Surg 2018; 53:271.e1-271.e5. [PMID: 30092428 DOI: 10.1016/j.avsg.2018.05.070] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/05/2018] [Accepted: 05/10/2018] [Indexed: 10/28/2022]
Abstract
We report an unusual complication of Chocolate nitinol-constraining structure after right superficial femoral artery (SFA) angioplasty. The procedure was performed by vascular surgeons in an operating theater equipped by a portable fluoroscopy unit. Under local anesthesia, by a contralateral approach, a 7F introducer sheath was advanced through the proximal portion of the right common iliac artery. Owing to the severe aorto-iliac vessels calcification, it was not possible to place the introducer sheath into a more distal vessel, as planned. After external iliac artery (EIA) stenting (7 × 80 mm Eluvia), SFA obstruction was intraluminal crossed, and a 6 × 120 mm nitinol-constrained balloon (Chocolate; Medtronic) was advanced in place and inflated. Once the balloon came out, the nitinol-constraining structure was not attached to the balloon surface. Under fluoroscopy, the crashed nitinol mesh was identified at distal edge of previously positioned EIA stent. To prevent mesh migration, it was fixed by covering with a 7 × 40 mm stent. The procedure was then successfully completed, as planned. One-month, postoperative computed tomography angiography showed complete expansion of the stents and no significant residual stenosis (>30%) in EIA, and SFA. Chocolate's mesh was still evident between the stent and the iliac artery wall, in absence of further complications. A 3 months follow-up, patient was still completely asymptomatic for claudication.
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Affiliation(s)
- Wassim Mansour
- Vascular and Endovascular Surgery Unit, Department of Surgery "P. Stefanini", Policlinico "Umberto I", "Sapienza" University of Rome, Rome, Italy.
| | - Virgilio Baldassarre
- Vascular and Endovascular Surgery Unit, Department of Surgery "P. Stefanini", Policlinico "Umberto I", "Sapienza" University of Rome, Rome, Italy
| | - Pasqualino Sirignano
- Vascular and Endovascular Surgery Unit, Department of Surgery "P. Stefanini", Policlinico "Umberto I", "Sapienza" University of Rome, Rome, Italy
| | - Laura Capoccia
- Vascular and Endovascular Surgery Unit, Department of Surgery "P. Stefanini", Policlinico "Umberto I", "Sapienza" University of Rome, Rome, Italy
| | - Simone Cuozzo
- Vascular and Endovascular Surgery Unit, Department of Surgery "P. Stefanini", Policlinico "Umberto I", "Sapienza" University of Rome, Rome, Italy
| | - Francesco Speziale
- Vascular and Endovascular Surgery Unit, Department of Surgery "P. Stefanini", Policlinico "Umberto I", "Sapienza" University of Rome, Rome, Italy
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Sirignano P, Capoccia L, Mansour W, Ronchey S, Accrocca F, Siani A, Mangialardi N, Speziale F. IP023. Type II Endoleak Incidence and Fate After Endovascular Aneurysm Repair by Low-Profile Polymer-Based Endograft Implantation in an Unselected Population∗. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.03.100] [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: 10/16/2022]
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Rodio DM, Bressan A, Ambrosi C, Scribano D, Tolli R, Mansour W, Speziale F, Antonelli G, Trancassini M, Pietropaolo V. Yersinia enterocolitica in Italy: A Case of Septicemia and Abdominal Aortic Aneurysm Infection. Front Med (Lausanne) 2018; 5:156. [PMID: 29881725 PMCID: PMC5978273 DOI: 10.3389/fmed.2018.00156] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/04/2018] [Indexed: 11/13/2022] Open
Abstract
We report a case of Yersinia enterocolitica septicemia in a 63-year-old patient admitted to the Vascular Surgery Department of Umberto I Hospital (Rome, Italy) for an abdominal aortic aneurysm. The microorganism, recovered from both peripheral blood cultures and aneurysmatic aortic wall specimens, was identified as Y. enterocolitica using matrix-assisted laser desorption ionization-time of flight analysis (MALDI-TOF MS) and 16S rDNA gene sequencing. The isolate responsible for septicemia belonged to the O:9 serotype (biogroup 2). A genetic screening of the isolate made it possible to detect the presence of both the yst and ail genes, encoding a heat-stable enterotoxin and a protein involved in invasion/adherence and serum resistance, respectively. Our case contributes in enriching epidemiological data concerning Y. enterocolitica infections, which might represent severe complications in patients suffering from cardiovascular diseases. Moreover, this study, together with the others, should be regarded as valuable and useful tools for monitoring the rate of infections worldwide.
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Affiliation(s)
- Donatella M. Rodio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alessia Bressan
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Cecilia Ambrosi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Dani Di Giò Foundation–Onlus, Rome, Italy
| | - Daniela Scribano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Rita Tolli
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana Mariano Aleandri, Rome, Italy
| | - Wassim Mansour
- Vascular and Endovascular Surgery Division, Department of Surgery Paride Stefanini, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Francesco Speziale
- Vascular and Endovascular Surgery Division, Department of Surgery Paride Stefanini, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Guido Antonelli
- Laboratory Affiliated to Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Maria Trancassini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Valeria Pietropaolo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Mansour W. SP-0437: DNA Repair: from mechanisms to clinical application. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30747-3] [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: 10/14/2022]
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Köcher S, Volquardsen J, Nordquist L, Lange T, Schlomm T, Beyer B, Petersen C, Rothkamm K, Mansour W. EP-2301: ERG overexpression in PCa drives a switch to the alt-EJ which render cells radiosensitive to PARPi. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32610-0] [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: 10/14/2022]
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Stilo F, Sirignano P, Montelione N, Mansour W, Capoccia L, Catanese V, Spinelli F, Speziale F. Bypass for symptomatic in-stent carotid restenosis. Int J Cardiol 2017; 249:392-395. [DOI: 10.1016/j.ijcard.2017.09.166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 07/08/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
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Sirignano P, Mansour W, Pranteda C, Siani A, Accrocca F, d'Adamo A, Capoccia L, Speziale F. Real-Life Experience with Ovation Stent Graft: Lesson Learned from the First One Hundred Fifty Treated Patients. Ann Vasc Surg 2017; 45:253-261. [DOI: 10.1016/j.avsg.2017.06.140] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/16/2017] [Accepted: 06/18/2017] [Indexed: 12/16/2022]
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Sirignano P, Capoccia L, Pranteda C, Montelione N, Mansour W, d’Adamo A, Formiconi M, Speziale F. Aortic Bifurcation Morphology Alone is Not Able to Predict Outcome in Patients Submitted to Elective Endovascular Abdominal Aortic Aneurysm Repair. Cardiovasc Intervent Radiol 2017; 41:218-224. [DOI: 10.1007/s00270-017-1831-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/25/2017] [Indexed: 12/01/2022]
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Montelione N, Sirignano P, Mansour W, Formiconi M, Capoccia L, Speziale F. Chimney Technique with the INCRAFT ® AAA Stent Graft System to Treat Pararenal Aortic Aneurysm in Narrowed Iliac Axes. Ann Vasc Surg 2017; 44:421.e9-421.e13. [DOI: 10.1016/j.avsg.2017.03.199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/11/2017] [Accepted: 03/26/2017] [Indexed: 10/19/2022]
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Sirignano P, Mansour W, Capoccia L, Pranteda C, Montelione N, Speziale F. Results of AFX Unibody Stent-Graft Implantation in Patients With TASC D Aortoiliac Lesions and Coexistent Abdominal Aortic Aneurysms. J Endovasc Ther 2017; 24:846-851. [DOI: 10.1177/1526602817730840] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Pasqualino Sirignano
- Vascular and Endovascular Surgery Unit, Department of Surgery “P Stefanini”, Policlinico “Umberto I,” “Sapienza” University of Rome, Italy
| | - Wassim Mansour
- Vascular and Endovascular Surgery Unit, Department of Surgery “P Stefanini”, Policlinico “Umberto I,” “Sapienza” University of Rome, Italy
| | - Laura Capoccia
- Vascular and Endovascular Surgery Unit, Department of Surgery “P Stefanini”, Policlinico “Umberto I,” “Sapienza” University of Rome, Italy
| | - Chiara Pranteda
- Vascular and Endovascular Surgery Unit, Department of Surgery “P Stefanini”, Policlinico “Umberto I,” “Sapienza” University of Rome, Italy
| | - Nunzio Montelione
- Vascular and Endovascular Surgery Unit, Department of Surgery “P Stefanini”, Policlinico “Umberto I,” “Sapienza” University of Rome, Italy
- Division of Vascular Surgery, University of Campus Bio-Medico, Rome, Italy
| | - Francesco Speziale
- Vascular and Endovascular Surgery Unit, Department of Surgery “P Stefanini”, Policlinico “Umberto I,” “Sapienza” University of Rome, Italy
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Sirignano P, Mansour W, Capoccia L, Speziale F. Rationale for a new registry on EVAR: The EXTREME study. Ann Med Surg (Lond) 2017; 21:7-8. [PMID: 28761639 PMCID: PMC5522917 DOI: 10.1016/j.amsu.2017.07.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/10/2017] [Accepted: 07/15/2017] [Indexed: 12/20/2022] Open
Abstract
To report rationale of a physician-initiated study: Expanding Indications for Treatment with Standard EVAR in Patients with Challenging Anatomies, a Multi-Centric Prospective Evaluation - EXTREME. Long term result after EVAR for AAA are still considered one of the main limits to the application of this treatment. According with IFU and guidelines, EVAR still has several anatomical limitation. Ovation Stent-Graft is an unique devices allowing to implement the range of patients amendable to be treated by EVAR.
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Affiliation(s)
- Pasqualino Sirignano
- Corresponding author. Vascular and Endovascular Surgery Division, Department of Surgery “Paride Stefanini”, Policlinico Umberto I of Rome, “Sapienza” University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy.Vascular and Endovascular Surgery DivisionDepartment of Surgery “Paride Stefanini”Policlinico Umberto I of Rome“Sapienza” University of RomeViale del Policlinico, 155Rome00161Italy
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Mansour W, Sirignano P, Pranteda C, d'Adamo A, Capoccia L, Speziale F. IP187. Isolated Common Iliac Artery Dissecting Aneurysms: A Report of Three Cases. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.03.197] [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: 11/30/2022]
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Capoccia L, Sirignano P, Mansour W, Pranteda C, Formiconi M, d'Adamo A, Fornelli F, Speziale F. FT11. Plaque Prolapse Prevention in Carotid Artery Stenting (3PCAS) Randomized Controlled Trial: Assessment of Subclinical Brain Lesions in CAS by Diffusion-Weighted Magnetic Resonance Imaging (DWMRI), Neuropsychometric Tests, and Neurobiomarkers Increase. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.03.037] [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: 10/19/2022]
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Sirignano P, Speziale F, Capoccia L, Mansour W, Pranteda C, Casana R, Setacci C. IF14. Thirty-Day Results From Prospective Multicenter Evaluation of Carotid Artery Stenting Using the CGuard Micronet-Covered Embolic Prevention Stent System in Real-World Population: the IRON-GUARD Study. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.03.063] [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: 10/19/2022]
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