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Turchino D, Peluso A, Accarino G, Accarino G, De Rosa C, D'Angelo A, Machi P, Mirabella D, Pecoraro F, Del Guercio L, Bracale UM, Dinoto E. A multicenter experience of three different "iliac branched" stent grafts for the treatment of aorto-iliac and/or iliac aneurysms. Ann Vasc Surg 2023:S0890-5096(23)00148-6. [PMID: 36921795 DOI: 10.1016/j.avsg.2023.02.033] [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: 12/14/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND The aim of study was to assess the safety and effectiveness of 3 different commercial iliac branch devices (IBDs): the Zenith Branch Iliac Endovascular Graft; the Gore Excluder Iliac Branch System and the E-liac Stent Graft System for the treatment of aorto-iliac or iliac aneurysms. METHODS From January 2017 to February 2020, a retrospective reviewed was conducted on a total of 96 patients. Primary endpoint was IBD instability rate at 24-months. Secondary endpoints included onset of any endoleaks, buttock claudication, IBD-related reintervention and all-death rates, post-operative acute kidney and changes in maximum diameter from baseline of the aortic aneurysmal sac. RESULTS At 24 months, the branch instability rate was similar amongst the three IBDs employed [Jotec 1/24 (4.1%), Gore 1/12 (8.3%), Cook 6/47 (12.7%), p-value = 0.502]. As well, no statistical difference in terms of branch-occlusion and branch-related endoleaks was observed. The Jotec group showed a significant decrease in maximum diameter from the baseline of the aortic aneurysmal sac when compared to the Gore group alone. No other differences were found relevant to the onset of any endoleaks, reinterventions and all-death rates. At 24-months, the Kaplan-Meier estimate of survival freedom from any branch instability was 95.8%, 91.6% and 86.8% for Jotec, Gore and Cook groups, respectively. CONCLUSIONS The use of IBDs represents a safe method for preserving patency of the IIA during treatment of aorto-iliac or iliac aneurysms providing a low rate of IBD instability.
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Affiliation(s)
- Davide Turchino
- Department of Public Health, Vascular Surgery Unit, University Federico II of Naples, Italy
| | - Antonio Peluso
- Department of Public Health, Vascular Surgery Unit, University Federico II of Naples, Italy
| | - Giancarlo Accarino
- Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Giulio Accarino
- Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Carmela De Rosa
- Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Antonio D'Angelo
- Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Pietro Machi
- Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy; Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy
| | - Domenico Mirabella
- Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy; Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy
| | - Felice Pecoraro
- Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy; Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy
| | - Luca Del Guercio
- Department of Public Health, Vascular Surgery Unit, University Federico II of Naples, Italy
| | | | - Ettore Dinoto
- Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy; Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy.
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Bracale UM, Peluso A, Di Mauro E, Del Guercio L, Di Taranto MD, Giannotta N, Ielapi N, Provenzano M, Andreucci M, Serra R. Carotid Endarterectomy versus Carotid Artery Stenting With Double-Layer Micromesh Carotid Stent: Contemporary Results of a Single-Center Retrospective Study. Ann Vasc Surg 2021; 82:41-46. [PMID: 34902476 DOI: 10.1016/j.avsg.2021.10.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Severe carotid stenosis (CS) is a major risk factor for stroke. Carotid Endarterectomy (CEA) is the gold standard revascularization technique of CS while carotid artery stenting (CAS) is considered an alternative treatment option, especially in high-risk patients or those with relative contraindications to CEA. The aim of this study was to evaluate the results of CEA and CAS with Roadsaver® stent device. METHODS We made a retrospective analysis of 119 patients undergoing treatment of CS. All CS were evaluated with imaging exams. The patients were divided into CEA group and CAS group. As primary endpoints of the study overall and cardiovascular cause - related mortality, freedom from stroke, and restenosis were considered. All patients were followed up and revaluated with duplex scan over a minimum of 6 months and a maximum of 36 months (follow-up mean time 22.3 ± 3.4 months). RESULTS In the whole cohort 86 of 119 patients underwent CEA and 33 of 119 CAS. Risk factors were superposable in both groups. During follow-up, we observed 4 deaths, 2 cardiovascular events and 12 restenosis. CEA was associated with lower death probability than CAS (P = 0.036). Probability of Restenosis and cardiovascular events did not vary between CAS and CEA groups. CONCLUSIONS Albeit CEA remains the gold standard for the treatment of severe CS, CAS with new double layer micromesh stent can be considered a useful and safe alternative in some clinical conditions.
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Affiliation(s)
| | - Antonio Peluso
- Department of Public Health, Vascular Surgery Unit, University Federico II of Naples, Italy
| | - Ernesto Di Mauro
- Department of Public Health, Vascular Surgery Unit, University Federico II of Naples, Italy
| | - Luca Del Guercio
- Department of Public Health, Vascular Surgery Unit, University Federico II of Naples, Italy
| | - Maria Donata Di Taranto
- Department of Molecular Medicine and Medical Biotechnology, University Federico II of Naples, Italy
| | - Nicola Giannotta
- Department of Medical and Surgical Sciences, University of Catanzaro, Italy
| | - Nicola Ielapi
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Italy
| | - Michele Provenzano
- Department of Medical and Surgical Sciences, University of Catanzaro, Italy
| | | | - Raffaele Serra
- Department of Medical and Surgical Sciences, University of Catanzaro, Italy.; Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology" at the Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy..
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Bracale U, Di Nuzzo MM, Bracale UM, Del Guercio L, Panagrosso M, Serra R, Terracciano RM, De Werra C, Corcione F, Peltrini R, Sodo M. Sequential Minimally Invasive Treatment of Concomitant Abdominal Aortic Aneurysm and Colorectal Cancer: A Single-Center Experience. Ann Vasc Surg 2021; 78:226-232. [PMID: 34492315 DOI: 10.1016/j.avsg.2021.07.009] [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: 06/11/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The surgical management of concomitant occurrence of abdominal aortic aneurysm (AAA) and colorectal cancer (CRC) is still controversial. Conversely, benefits from a minimally invasive approach are well known concerning the treatment of both AAA and CRC. The aim of this study is to assess safety and feasibility of a sequential 2-staged minimally invasive during the same recovery by endovascular aneurysm repair (EVAR) technique and laparoscopic colorectal resection. METHODS From January 2008 to December 2020, all patients with concomitant AAA and CRC were consecutively treated by EVAR and laparoscopic colorectal resection. Perioperative data were retrospectively collected in order to evaluate short- and long-term outcomes following the sequential 2-staged procedures. RESULTS A total of 24 patients were included. The localization of the aneurysm was infrarenal abdominal aortic in 23 cases and in one case of common iliac artery. EVAR procedure has always been performed first. In 18 patients, a percutaneous access has been used while in 6 patients a surgical access has been adopted. Twelve patients had cancer in the left colon, 9 in the right colon, and 3 patients had rectal cancer. No conversions or intraoperative complications had occurred during laparoscopic surgery. The major complications rate after EVAR and CRC surgery was 8.3% and 12.5%, respectively. The mean interval between EVAR and CRC treatment was 7.8 ± 1 and the mean length of stay was 15.4 ± 3.6. No deaths occurred during hospitalization and between the procedures. Overall mortality was 20.8% with a mean follow-up of 39.41 ± 19.2 months. CONCLUSION Elective sequential 2-staged minimally invasive treatment is a safe and feasible approach with acceptable morbidity and mortality rates and it should be adopted in current clinical practice to manage concomitant AAA and CRC.
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Affiliation(s)
- Umberto Bracale
- Department of Public Health, Minimally Invasive General and Oncological Surgery Unit, University of Naples Federico II, Naples, Italy
| | - Maria Michela Di Nuzzo
- Department of Public Health, Minimally Invasive General and Oncological Surgery Unit, University of Naples Federico II, Naples, Italy
| | - Umberto Marcello Bracale
- Department of Public Health, Vascular Surgery Unit, University of Naples Federico II, Naples, Italy
| | - Luca Del Guercio
- Department of Public Health, Vascular Surgery Unit, University of Naples Federico II, Naples, Italy
| | - Marco Panagrosso
- Department of Public Health, Vascular Surgery Unit, University of Naples Federico II, Naples, Italy
| | - Raffaele Serra
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Rosa Maria Terracciano
- Department of Public Health, Minimally Invasive General and Oncological Surgery Unit, University of Naples Federico II, Naples, Italy
| | - Carlo De Werra
- Department of Public Health, Minimally Invasive General and Oncological Surgery Unit, University of Naples Federico II, Naples, Italy
| | - Francesco Corcione
- Department of Public Health, Minimally Invasive General and Oncological Surgery Unit, University of Naples Federico II, Naples, Italy
| | - Roberto Peltrini
- Department of Public Health, Minimally Invasive General and Oncological Surgery Unit, University of Naples Federico II, Naples, Italy.
| | - Maurizio Sodo
- Department of Public Health, Minimally Invasive General and Oncological Surgery Unit, University of Naples Federico II, Naples, Italy
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Bracale UM, Ammollo RP, Hussein EA, Hoballah JJ, Taurino M, Saleem BR, Setacci C, Pecoraro F, Serra R, Bracale G, Panagrosso M, Peluso A, Petrone A, Maisto M, Del Guercio L, Dinoto E, Bajardi G, Bouayed MN, Zeebregts CJ, Pulli R, Pane B, Pratesi G, Castelli P, Setacci F, Gargiulo M, Stella A, Illario M, De Luca V, Verhoeven ELG, Riambau V, Saratzis N, Cvjetko I, Resch T, Fernandes E Fernandes J, Chiche L, Goeau-Brissonniere O. Position Paper on Young Vascular Surgeons Training of the Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS): State of the Art and Perspectives. Ann Vasc Surg 2021; 77:e7-e13. [PMID: 34454017 DOI: 10.1016/j.avsg.2021.08.002] [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: 07/31/2021] [Accepted: 08/05/2021] [Indexed: 10/20/2022]
Abstract
The Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS) was founded in 2018, with the aim to promote cooperation among vascular professionals within Mediterranean countries. Due to its prominent social and economic impact on national health systems, diabetic peripheral artery was selected as the very first topic to be investigated by the federation. In this second paper, different experiences from delegates of participating countries were shared to define common strategies to harmonize, standardize, and optimize education and training in the Vascular Surgery specialty.
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Affiliation(s)
- Umberto Marcello Bracale
- Vascular and Endovascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy.
| | - Raffaele Pio Ammollo
- Vascular and Endovascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Emad A Hussein
- Department of Vascular Surgery, Ain Shams University, Cairo, Egypt
| | - Jamal J Hoballah
- Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maurizio Taurino
- Unit of Vascular Surgery, Department of Clinical and Molecular Medicine, "Sapienza", University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Ben R Saleem
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, Groningen, The Netherlands
| | - Carlo Setacci
- Vascular and Endovascular Surgery Unit, Department of Medicine, Surgery and Neurological Sciences, Policlinico S. Maria alle Scotte, University of Siena, Italy
| | - Felice Pecoraro
- Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Vascular Surgery Unit, Palermo, Italy
| | - Raffaele Serra
- Department of Medical & Surgical Sciences University Magna Graecia of Catanzaro, Italy
| | - Giancarlo Bracale
- Vascular and Endovascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy; Health Innovation Unit, Campania Region, Naples, Italy
| | | | - Marco Panagrosso
- Vascular and Endovascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Antonio Peluso
- Vascular and Endovascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Anna Petrone
- Vascular and Endovascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Marianna Maisto
- Vascular and Endovascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Luca Del Guercio
- Vascular and Endovascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Ettore Dinoto
- Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Vascular Surgery Unit, Palermo, Italy
| | - Guido Bajardi
- Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Vascular Surgery Unit, Palermo, Italy
| | | | - Clark J Zeebregts
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, Groningen, The Netherlands
| | - Raffaele Pulli
- Vascular Surgery, Department of Cardiothoracic Surgery, University of Bari, Bari, Italy
| | - Bianca Pane
- Clinic of Vascular and Endovascular Surgery, Ospedale Policlinico San Martino, Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, Italy
| | - Giovanni Pratesi
- Clinic of Vascular and Endovascular Surgery, Ospedale Policlinico San Martino, Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, Italy
| | - Patrizio Castelli
- Research Centre for Vascular Surgery, Department of Medicine and Surgery, University of Insubria, Italy
| | - Francesco Setacci
- Unit of Vascular Surgery, Multimedica Institute for Research and Care, Milan, Italy
| | - Mauro Gargiulo
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Andrea Stella
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Maddalena Illario
- Health Innovation Unit, Campania Region, Naples, Italy; Research and Development Unit, AOU "Federico II", Naples, Italy
| | | | - Eric L G Verhoeven
- Department of Vascular and Endovascular Surgery, Klinikum Nuremberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Vincent Riambau
- Vascular Surgery Division, Thorax Institute, Hospital Clinic, Barcelona, Spain
| | - Nikolaos Saratzis
- 1st Department of Surgery and Vascular Surgery, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ivan Cvjetko
- Clinical Department of Vascular Surgery, University Hospital Merkur, Zagreb, Croatia
| | - Timothy Resch
- Vascular Center Malmö-Lund, Skåne University Hospital, Sweden
| | | | - Laurent Chiche
- Sorbonne Université, Department of Vascular Surgery, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, France
| | - Olivier Goeau-Brissonniere
- Department of Vascular Surgery, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, France; Faculté de Médecine Paris Ile-de-France Ouest, Paris, France
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Bracale UM, Turchino D, Accarino G, Petrone A, Del Guercio L, Sodo M, Fornino G, Accarino G, Ielapi N, Serraino GF, Mastroroberto P, Provenzano M, Andreucci M, Serra R. Efficacy and Safety of Jotec E-Ventus BX Stent Graft for Iliac Branch Device Procedure: A Retrospective Clinical Study. Ann Vasc Surg 2021; 77:202-207. [PMID: 34437964 DOI: 10.1016/j.avsg.2021.05.053] [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: 04/12/2021] [Revised: 05/21/2021] [Accepted: 05/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The endovascular aneurysm repair (EVAR) is a successful treatment for aorto-iliac aneurysms. The success of EVAR is enhanced by the use of devices that maintain the patency of targeted arteries namely the iliac branch device (IBD) With this study we aimed to evaluate the association between the use of Jotec E-ventus during EVAR with IBD and prognosis in patients with aorto-iliac aneurysms. METHODS This is a retrospective, multicentric study enrolling patients referred to our Vascular Surgery Units from January 2015 to January 2020. All patients underwent EVAR with IBD using Jotec E-ventus as bridging stent. Primary endpoint was the development of types I and III endoleaks. Secondary endpoint was the onset of device occlusion with loss of vascular patency. RESULTS We studied 32 patients (mean age 71.7±4.5y). Of these, 25 patients were treated with standard EVAR procedure whereas 7 were treated with isolated IBD due to extension of disease involving iliac bifurcation. Median follow-up lasted 15[IQR11-27] months. During follow-up, incidence rates for endoleaks and occlusion were 3.98(95%CI 0.48-14.41) and 1.99(95%CI 0.05-11.12) per 100 pts/year. CONCLUSIONS Jotec E-ventus during EVAR is associated with a low rate of severe complications in a small cohort of patients with aorto-iliac aneurysms.
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Affiliation(s)
| | - Davide Turchino
- Department of Public Health, University of Naples "Federico II", Naples, Italy; Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Giancarlo Accarino
- Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Anna Petrone
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Luca Del Guercio
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Maurizio Sodo
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Giovanni Fornino
- Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Giulio Accarino
- Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Nicola Ielapi
- Department of Public Health and Infectious Disease, "Sapienza" University of Rome, Roma, Italy
| | | | - Pasquale Mastroroberto
- Department of Experimental and Clinical Medicine, University of Catanzaro, Catanzaro, Italy
| | - Michele Provenzano
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa Catanzaro, Italy
| | - Michele Andreucci
- Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Raffaele Serra
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa Catanzaro, Italy; Interuniversity Center of Phlebolymphology (CIFL), "Magna Graecia" University, Catanzaro, Italy.
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Serra R, Bracale UM, Ielapi N, Del Guercio L, Di Taranto MD, Sodo M, Michael A, Faga T, Bevacqua E, Jiritano F, Serraino GF, Mastroroberto P, Provenzano M, Andreucci M. The Impact of Chronic Kidney Disease on Peripheral Artery Disease and Peripheral Revascularization. Int J Gen Med 2021; 14:3749-3759. [PMID: 34326661 PMCID: PMC8315808 DOI: 10.2147/ijgm.s322417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/05/2021] [Indexed: 12/11/2022] Open
Abstract
Chronic kidney disease (CKD) is a clinical condition characterized by high morbidity and mortality. Globally, CKD is also increasing in prevalence and incidence. The two principal kidney measures namely estimated glomerular filtration rate (eGFR) and albuminuria have been found to be predictors of renal and cardiovascular (CV) endpoints including peripheral artery disease (PAD). The prevalence of PAD was increased in CKD patients and, particularly, in patients with more severe CKD stages. Despite the fact that revascularization strategies are suitable in CKD patients in similar fashion to non-CKD patients, few CKD patients underwent these procedures. In fact, if it is true that revascularization improves prognosis in PAD patients irrespective of baseline eGFR, it was also demonstrated that CKD patients, who underwent revascularization, were at higher risk for amputations, mortality, re-intervention and perioperative complications. With the present review article, we have examined the association between CKD, PAD and peripheral revascularization highlighting data about epidemiology, pathophysiologic mechanisms, and results from previous observational and intervention studies. We have also examined the future perspectives and challenges of research around the association between CKD and PAD.
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Affiliation(s)
- Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), "Magna Graecia" University, Catanzaro, Italy.,Department of Surgical and Medical Sciences, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, 88100, Italy
| | | | - Nicola Ielapi
- Department of Public Health and Infectious Disease, "Sapienza" University of Rome, Roma, 00185, Italy
| | - Luca Del Guercio
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Maria Donata Di Taranto
- Department of Molecular Medicine and Medical Biotechnology, University Federico II of Naples, Naples, Italy
| | - Maurizio Sodo
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Ashour Michael
- Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Teresa Faga
- Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Egidio Bevacqua
- Department of Experimental and Clinical Medicine, University of Catanzaro, Catanzaro, 88100, Italy
| | - Federica Jiritano
- Department of Experimental and Clinical Medicine, University of Catanzaro, Catanzaro, 88100, Italy
| | | | - Pasquale Mastroroberto
- Department of Experimental and Clinical Medicine, University of Catanzaro, Catanzaro, 88100, Italy
| | - Michele Provenzano
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, 88100, Italy
| | - Michele Andreucci
- Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
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Bracale UM, Petrone A, Provenzano M, Ielapi N, Ferrante L, Turchino D, Del Guercio L, Pakeliani D, Andreucci M, Serra R. The use of the Amplatzer Vascular Plug in the prevention of endoleaks during abdominal endovascular aneurysm repair: A systematic literature review on current applications. Vascular 2021; 30:681-689. [PMID: 34126806 DOI: 10.1177/17085381211025152] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The Amplatzer Vascular Plug (AVP) is a vascular occlusion device designed to provide optimal embolization in several fields of the endovascular surgery. A full literature review was conducted to analyze AVPs in comparison with coils for the prevention of endoleaks during endovascular abdominal aortic aneurysm repair. METHODS A systematic review was designed under PRISMA statement guidelines for systematic reviews and meta-analyses. The results were updated with a subsequent electronic search using Medline and Scopus databases up to December 2019. RESULTS Eighteen articles making this comparison were found. In 79.7% of the cases, the target vessel was the internal iliac artery; in 1.6%, the common iliac artery; and in 16.7%, the inferior mesenteric artery. Risk of complications (buttock claudication, groin hematoma, endoleaks, and erectile dysfunction) after AVP was low. A cost comparison revealed that the mean cost for coils was around US$2262, while the average cost for the AVP was US$310. CONCLUSIONS The AVP is an effective and safe device for occluding peripheral vessels, proved to have lower complications rates. Compared with coil embolization, the AVP technique is potentially associated with lower procedural costs.
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Affiliation(s)
- Umberto M Bracale
- Department of Public Health, Vascular Surgery Unit, 9307University Federico II of Naples, Napoli, Italy
| | - Anna Petrone
- Department of Public Health, Vascular Surgery Unit, 9307University Federico II of Naples, Napoli, Italy
| | - Michele Provenzano
- Department of Medical and Surgical Sciences, 9325University of Catanzaro, Catanzaro, Italy
| | - Nicola Ielapi
- Department of Public Health and Infectious Disease, 9311Sapienza University of Rome, Roma, Italy.,Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Catanzaro, Italy
| | - Liborio Ferrante
- Department of Public Health, Vascular Surgery Unit, 9307University Federico II of Naples, Napoli, Italy
| | - Davide Turchino
- Department of Public Health, Vascular Surgery Unit, 9307University Federico II of Naples, Napoli, Italy
| | - Luca Del Guercio
- Department of Public Health, Vascular Surgery Unit, 9307University Federico II of Naples, Napoli, Italy
| | - David Pakeliani
- Vascular Surgery Unit, 9341"Villa Sofia" Hospital, Palermo, Italy
| | - Michele Andreucci
- Department of Medical and Surgical Sciences, 9325University of Catanzaro, Catanzaro, Italy
| | - Raffaele Serra
- Department of Medical and Surgical Sciences, 9325University of Catanzaro, Catanzaro, Italy.,Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Catanzaro, Italy
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Garbuglio R, Turchino D, Giribono AM, Viviani E, Ferrante L, Sodo M, Del Guercio L, Bracale UM. Ancient schwannoma mimicking a carotid body tumor A case report and review of the literature. Ann Ital Chir 2020; 9:S2239253X20031448. [PMID: 31957705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Ancient Schwannoma is a type of peripheral neurogenic tumor formed by the Schwann cells presenting mainly as a benign and asymptomatic lesion. The neurilemmoma tumor appears in different sites and, in cases of cervical location, can mimic a carotid body tumor. Herein we describe a clinical case of a 51-year-old woman with latero-cervical swelling. A contrast-enhanced computed tomography scan revealed a classical wineglass image mimicking a carotid body tumor. During surgery the tumor appeared connected to the cervical sympathetic trunk without carotid involvement. The histological exam confirmed the nature of the mass which consisted of an ancient schwannoma. A subsequent systematic review of the literature on ancient schwannoma incidence and treatment confirms it being a benign and rare lesion primarily treatable with open surgery. KEY WORDS: Ancient Schwannoma, Carotid body tumor, Carotid artery, Vascular surgery.
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Bracale UM, Giribono AM, Spinelli D, Del Guercio L, Pipitò N, Ferrara D, Barillà D, Barbarisi D, Derone G, Benedetto F. Long-term Results of Endovascular Treatment of TASC C and D Aortoiliac Occlusive Disease with Expanded Polytetrafluoroethylene Stent Graft. Ann Vasc Surg 2018; 56:254-260. [PMID: 30339903 DOI: 10.1016/j.avsg.2018.07.060] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/10/2018] [Accepted: 07/15/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of this study is to retrospectively analyze the early and long-term outcomes of endovascular treatment of Trans-Atlantic Inter-Society Consensus II class C and D (TASC II) aortoiliac occlusive disease with an expanded polytetrafluoroethylene-covered stent graft. METHODS Between January 2006 and November 2017, 61 patients (53 males, 8 females), with symptomatic aortoiliac stenotic and/or occlusive disease, were treated with VIABAHN (W.L. Gore and Associates, Flagstaff, Ariz) at 2 University medical centers. The morphology of the lesions was evaluated and classified by contrast-enhanced computed tomography angiography. Demographic data, operation details, and postoperative outcomes were collected. Follow-up data were analyzed by a life-table analysis (Kaplan-Meier test). RESULTS Mean age of the patients was 64.89 ± 10.77 years (range 44-89). Thirty-seven patients (60.7%) presented with severe claudication (Rutherford 3), whereas 21 (34.4%) were in Rutherford class 4 and the remaining 3 patients (4.9%) suffered from necrotic lesions (Rutherford 5/6). Fifty-six patients were smokers (91.8%), 38 (62.3%) had hypertension, 23 (37.7%) had coronary artery disease, 30 (40.2%) had dyslipidemia, 18 (29.5%) had chronic obstructive pulmonary disease, 6 (9.5%) had renal insufficiency (serum creatinine>2.0 mg/dL) and 24 (39.3%) had diabetes. Technical success was achieved in 59/61 patients (96.7%) with 16 patients (26.2%) requiring combined percutaneous brachial access to obtain iliac recanalization. Perioperative mortality was 1.6%, whereas postoperative major complications occurred in 2 patients (3.6%). The mean number of VIABAHN placed was 1.77/patient. Mean follow-up was 31.5 months (range 1-108) and primary patency at 36 months was 94.9%. Two major amputations of the lower limbs occurred during the follow-up. CONCLUSIONS Open surgery with the aortobifemoral bypass has been the gold standard treatment for complex aortoiliac occlusive disease although complications and mortality still remain significant issues. Our results suggest that endovascular therapy of TASC C and D iliac lesions using the VIABAHN stent graft is feasible, effective, and has good, long-term patency.
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Affiliation(s)
- Umberto Marcello Bracale
- Vascular and Endovascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Anna Maria Giribono
- Vascular and Endovascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Domenico Spinelli
- Unit of Vascular Surgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
| | - Luca Del Guercio
- Vascular and Endovascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Narayana Pipitò
- Unit of Vascular Surgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Doriana Ferrara
- Vascular and Endovascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy
| | - David Barillà
- Unit of Vascular Surgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Danilo Barbarisi
- Vascular and Endovascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Graziana Derone
- Unit of Vascular Surgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Filippo Benedetto
- Unit of Vascular Surgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
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Garbuglio R, Turchino D, Giribono AM, Del Guercio L, Bracale UM. A case of symptomatic popliteal vein aneurysm. Ann Ital Chir 2018; 7:S2239253X18028463. [PMID: 29683433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
UNLABELLED We describe a case of a 44 year-old man with a subcutaneous swelling in the left popliteal fossa. The patient complained pain posteriorly to the left knee since several months and presented with a saccular aneurysm of the left popliteal vein (PVA) with reflux clearly evidenced at duplex ultrasound scan (DUS), but in absence of thrombus inside and without clinical signs of embolism. The patient was treated surgically by aneurysmectomy with lateral venorrhaphy according to Aldridge technique and a duplex ultrasound scan after six months revealed a complete patency of the left popliteal vein. According to literature evidences and our center experience, the surgical treatment of the popliteal vein aneurysm represents the gold standard in order to prevent the possible complications like development of thrombus inside the aneurysmatic vein and the consequent embolic risk and it is recommended in all case of a symptomatic saccular type of whatever diameter, and in fusiform type >20 mm, with or without thrombus. KEY WORDS Complications, Popliteal vein aneurysm, Vascular Surgery.
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11
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De Gregorio C, Spalla F, Padricelli A, Narese D, Bracale U, Ferrara D, Del Guercio L, Bracale UM. The Endovascular Management of an Iatrogenic Superior Gluteal Artery Rupture Following Bone Marrow Biopsy. Intern Med 2017; 56:2639-2643. [PMID: 28883230 PMCID: PMC5658532 DOI: 10.2169/internalmedicine.8195-16] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report an uncommon case of a life-threatening retroperitoneal hematoma after a bone marrow biopsy. Two hours after iliac crest bone harvesting, the patient experienced syncope and severe hypotension. Urgent contrast-enhanced computed tomography demonstrated extravasation from the superior gluteal artery. Transcatheter coil embolization was performed successfully, without complications. Life-threatening complications caused by retroperitoneal bleeding after bone marrow biopsy are very rare. There are few reports on the use of endovascular treatment in the management of life-threatening hemorrhagic complications after bone marrow biopsy.
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Affiliation(s)
- Claudia De Gregorio
- Department of Vascular and Endovascular Surgery, University Federico II of Naples, Italy
| | - Flavia Spalla
- Department of Vascular and Endovascular Surgery, University Federico II of Naples, Italy
| | - Andrea Padricelli
- Department of Vascular and Endovascular Surgery, University Federico II of Naples, Italy
| | | | - Umberto Bracale
- Department of General Surgery, University Federico II of Naples, Italy
| | - Doriana Ferrara
- Department of Vascular and Endovascular Surgery, University Federico II of Naples, Italy
| | - Luca Del Guercio
- Department of Vascular and Endovascular Surgery, University Federico II of Naples, Italy
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Filippo MD, Barbarisi D, Ferrara D, Brancaccio S, Del Guercio L, Bracale R, Capuano A, Esposito G, Bracale UM. Hemodialysis Arteriovenous Access Occlusion Using the Amplatzer Vascular Plug in Patients with Intractable Arm Edema. Case Rep Nephrol Dial 2017; 7:63-72. [PMID: 28868296 PMCID: PMC5566693 DOI: 10.1159/000477663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/21/2017] [Indexed: 11/30/2022] Open
Abstract
Objectives Vascular occlusion of hemodialysis arteriovenous access (AVA) using an Amplatzer vascular plug (AVP; St. Jude Medical, St. Paul, MN, USA) is an arising and alternative practice in selected patients; however, few reported cases can be found in the literature. Herein, we report on our experience with endovascular treatment of complicated AVA. Materials and Methods From September 2015 to December 2016, 3 patients at our clinic underwent an occlusion of hemodialysis AVA with 2 different Amplatzer vascular plugs: 2 patients with type II and 1 patient with type IV. Of these, 1 patient was treated for an autologous radiocephalic fistula, the second patient was treated for an autologous brachiocephalic fistula located at the elbow, and the third was, instead, treated for a radiocephalic forearm fistula. The reason for closing the AVA in all patients was due to the presence of dialysis-associated steal syndrome with critical hand ischemia and intractable ipsilateral edema. Results All AVAs were treated using an AVP. No plug migration, access revascularization, persistent ischemia, nor other complications were observed. Conclusion This report suggests that the use of AVP for embolization of complicated AVA is a safe and reasonable alternative to open surgery in selected patients.
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Affiliation(s)
- Michele Di Filippo
- Vascular and Endovascular Surgery Unit, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Danilo Barbarisi
- Vascular and Endovascular Surgery Unit, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Doriana Ferrara
- Vascular and Endovascular Surgery Unit, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Stefania Brancaccio
- Nephrology Unit, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Luca Del Guercio
- Vascular and Endovascular Surgery Unit, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Renata Bracale
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Alfredo Capuano
- Nephrology Unit, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Umberto Marcello Bracale
- Vascular and Endovascular Surgery Unit, Department of Public Health, University of Naples Federico II, Naples, Italy
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Padricelli A, Giribono AM, Ferrara D, Spalla F, Bracale U, Del Guercio L, Servillo G, Ruotolo C, Bracale UM. Severe Mesenteric Ischemia in a Pregnant Woman with Antiphospholipid Syndrome. Ann Vasc Surg 2017; 44:415.e11-415.e16. [PMID: 28483615 DOI: 10.1016/j.avsg.2017.04.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 11/18/2022]
Abstract
The antiphospholipid syndrome (APS), either primary or secondary form, is considered an autoimmune disease with the presence of at least 1 clinical and 1 laboratory abnormalities as defined by the Sydney criteria. Clinical criteria include vascular thrombosis of venous, artery, small vessel in any organ, and recurrent pregnancy pathologies. Mesenteric ischemia is a rare and threatening manifestation of APS. We herein report a case of a 34-year-old pregnant woman referred to our Emergency Room with thoracic and abdominal acute pain. Her past medical history was remarkable for positivity to antiphospholipid antibodies, deep vein thrombosis of the right lower limb, chronic occlusion of celiac trunk, and superior mesenteric artery and recurrent abortions. Imaging revealed acute occlusion of inferior mesenteric artery (IMA). Both a surgical and endovascular thrombectomy were ineffective to obtain durable IMA patency and so the patient underwent antegrade aorta-inferior mesenteric bypass with saphenous vein and resection of an ischemic ileal loop. The medical treatment at discharge was lifelong oral anticoagulant associated with double antiplatelet therapy. To the best of our knowledge, this is the first case reporting a young pregnant woman with APS and mesenteric ischemia submitted to several attempts of revascularization. Aggressive oral anticoagulant and antiplatelet long-term therapy is advised. Moreover, we recommend strict follow-up in those patients in order to early diagnose thrombotic recurrence.
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Affiliation(s)
- Andrea Padricelli
- Department of Public Health, Vascular and Endovascular Surgery Unit, University Federico II of Naples, Naples, Italy
| | - Anna Maria Giribono
- Department of Public Health, Vascular and Endovascular Surgery Unit, University Federico II of Naples, Naples, Italy
| | - Doriana Ferrara
- Department of Public Health, Vascular and Endovascular Surgery Unit, University Federico II of Naples, Naples, Italy
| | - Flavia Spalla
- Department of Public Health, Vascular and Endovascular Surgery Unit, University Federico II of Naples, Naples, Italy
| | - Umberto Bracale
- Department of Public Health, General Surgery Unit, University Federico II of Naples, Naples, Italy
| | - Luca Del Guercio
- Department of Public Health, Vascular and Endovascular Surgery Unit, University Federico II of Naples, Naples, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Carlo Ruotolo
- Department of Vascular Surgery, Vascular Surgery Unit, "A. Cardarelli" Hospital of Naples, Naples, Italy
| | - Umberto Marcello Bracale
- Department of Public Health, Vascular and Endovascular Surgery Unit, University Federico II of Naples, Naples, Italy.
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Giribono AM, Ferrara D, Spalla F, Narese D, Bracale U, Pecoraro F, Bracale R, Del Guercio L, Bracale UM. Endovascular treatment of spontaneous isolated abdominal aortic dissection. Acta Radiol Open 2016; 5:2058460116681042. [PMID: 27994881 PMCID: PMC5152934 DOI: 10.1177/2058460116681042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 06/10/2016] [Accepted: 11/01/2016] [Indexed: 11/25/2022] Open
Abstract
Isolated abdominal aortic dissection is a rare clinical disease representing only 1.3% of all dissections. There are a few case series reported in the literature. The causes of this pathology can be spontaneous, iatrogenic, or traumatic. Most patients are asymptomatic and symptoms are usually abdominal or back pain, while claudication and lower limb ischemia are rare. Surgical and endovascular treatment are two valid options with acceptable results. We herein describe nine cases of symptomatic spontaneous isolated abdominal aortic dissection, out of which four successfully were treated with an endovascular approach between July 2003 and July 2013. All patients were men, smokers, symptomatic (either abdominal or back pain or lower limb ischemia), with a history of high blood pressure, with a medical history negative for concomitant aneurysmatic dilatation or previous endovascular intervention. Diagnosis of isolated abdominal aortic dissection were established by contrast-enhanced computed tomography angiography (CTA) of the thoracic and abdominal aorta. All nine patients initially underwent medical treatment. In four symptomatic cases, non-responsive to medical therapy, bare-metal stents or stent grafts were successfully positioned. All patients completed a CTA follow-up of at least 12 months, during which they remained symptom-free. Endovascular management of this condition is associated with a high rate of technical success and a low mortality; therefore, it can be considered the treatment of choice when it is feasible.
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Affiliation(s)
- Anna Maria Giribono
- Department of Vascular and Endovascular Surgery University Federico II of Naples, Naples, Italy
| | - Doriana Ferrara
- Department of Vascular and Endovascular Surgery University Federico II of Naples, Naples, Italy
| | - Flavia Spalla
- Department of Vascular and Endovascular Surgery University Federico II of Naples, Naples, Italy
| | - Donatella Narese
- Department of Radiology, DIBIMEF, University of Palermo, Palermo, Italy
| | - Umberto Bracale
- Department of General Surgery, University Federico II of Naples, Naples, Italy
| | - Felice Pecoraro
- Vascular Surgery Unity, University of Palermo, Palermo, Italy
| | - Renata Bracale
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Luca Del Guercio
- Department of Vascular and Endovascular Surgery University Federico II of Naples, Naples, Italy
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Ferrara D, Di Filippo M, Spalla F, Giribono AM, Viviani E, Santagata A, Bracale U, Santangelo M, Del Guercio L, Bracale UM. Giant true Brachial Artery Aneurysm after Hemodialysis Fistula Closure in a Renal Transplant Patient. Case Rep Nephrol Dial 2016; 6:128-132. [PMID: 27904865 PMCID: PMC5121550 DOI: 10.1159/000452299] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 08/08/2016] [Accepted: 10/07/2016] [Indexed: 11/19/2022] Open
Abstract
The usual manifestation of brachial artery aneurysms is the incidental finding of a swelling of the arm, combined with paresthesia or pain in some cases. The etiology is often traumatic or secondary to drug abuse. Pathophysiology of brachial artery dilation in these cases is not completely clear. We herein describe a case of a 61-year-old male presenting with a giant, painful, pulsatile mass on his left arm. He was submitted to a cadaveric kidney transplant in 2005. He had a functioning arteriovenous fistula (AVF) on his right arm, and a spontaneously thrombosed radiocephalic AVF on his left arm. The aneurysm was surgically resected, sparing the median nerve that was totally entrapped and an inverted segment of the basilic vein interposed. At the follow-up, the patient did not present neurological or ischemic disturbs, and the vein graft maintained its patency.
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Affiliation(s)
- Doriana Ferrara
- Operative Unit of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy
| | - Michele Di Filippo
- Operative Unit of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy
| | - Flavia Spalla
- Operative Unit of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy
| | - Anna Maria Giribono
- Operative Unit of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy
| | - Emanuela Viviani
- Operative Unit of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy
| | - Annamaria Santagata
- Operative Unit of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy
| | - Umberto Bracale
- Operative Unit of General Surgery, University Federico II of Naples, Naples, Italy
| | - Michele Santangelo
- Operative Unit of General Surgery & Transplants, University Federico II of Naples, Naples, Italy
| | - Luca Del Guercio
- Operative Unit of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy
| | - Umberto Marcello Bracale
- Operative Unit of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy
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Viviani E, Giribono AM, Narese D, Ferrara D, Servillo G, Del Guercio L, Bracale UM. Gluteal Compartment Syndrome Following Abdominal Aortic Aneurysm Treatment: Case Report and Review of the Literature. INT J LOW EXTR WOUND 2016; 15:354-359. [PMID: 27581114 DOI: 10.1177/1534734616663748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Compartment syndrome (CS) is a pathological increase of the interstitial pressure within the closed osseous fascial compartments. Trauma is the most common cause, followed by embolization, burns, and iatrogenic injuries; it usually involves the limbs. The major issue when dealing with CS is the possibility to do an early diagnosis in order to intervene precociously, through a fasciotomy, reducing the risk of tissue, vascular and nervous damage. Although it is an infrequent condition, it is potentially life threatening. In our case report, we present a 59-year-old patient, smoker, affected by hypertension, dyslipidemia, chronic renal failure, and morbid obesity who came at our attention for a 6-cm abdominal aorta aneurysm, treated with an aorto-aortic graft. Within 24 hours from surgery, the patient presented acute ischemia of the right lower limb due to thrombosis of the common iliac artery and underwent the positioning of a kissing stent at the aortic bifurcation. In the immediate postoperative period, a relevant increase in serum creatinine, creatine phosphokinase, and myoglobin value was recorded, associated with clinical presentation of swelling in the right buttock with intense pain. The diagnosis of gluteal CS was confirmed by the measurement of the gluteal compartment pressure, which resulted of 110 mm Hg. The treatment of the CS consisted in gluteal dermofasciotomy, surgical debridement of the buttock, and positioning of negative pressure medication, associated with infusive therapy, avoiding hemodialysis. Because of the epidural anesthesia only later on it was possible to observe a persistent plegia of the right lower limb, which was solved within 1 month of neurological and physical therapy. With our experience, we can state that the CS is an extremely severe complication that can occur in vascular surgeries and it should therefore be kept in mind in the short-term postoperative period in order to guarantee a precocious diagnosis and immediate treatment.
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Bracale UM, Spalla F, Caioni F, Solari D, Narese D, Pecoraro F, Del Guercio L. Pre and postoperative evaluation of transcranial Doppler pulsatility index of the middle cerebral artery in patients with severe carotid artery stenosis. Ann Ital Chir 2016; 87:209-213. [PMID: 27346595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED In the management of severe carotid artery stenosis particular importance must be given to the evaluation of the risk of perioperative cerebral ischemic events. Our study analysed the possible relationship between the pre-operative middle cerebral artery Gosling Index, calculated after transcranial Doppler (TCD), and intra-operative stump pressure (SP), in order to identify patients with higher risk of ischemic accidents. Moreover, we studied pre- and post- operative Gosling Index values in association with possible events during follow-up. In a one-year time lapse 47 patients underwent either carotid endoarterectomy (CEA) or carotid artery stenting (CAS) with proximal embolic protection system. All patients were subject to pre- and post-operative TCD with calculation of the Gosling Index and intra-operative SP. We observed that higher pre-operative Gosling Index values are associated with lower intra-operative SP values, elements that represent a higher risk for cerebro-vascular ischemic accidents; this result is particularly evident when observing the diabetic sub-population. An increase in ischemic events did not present statistically significant differences when observing the populations treated with CEA or CAS. TCD and SP are valid and simple exams that can help identify precociously patients with a higher risk of cerebro-vascular accidents related to surgical or endovascular treatment. KEY WORDS Carotid artery stenosis, Carotid endarterectomy, Endovascular treatment.
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Bracale UM, Merola G, Del Guercio L, Sodo M, Giribono AM, Bracale U. Emergency endovascular management of the common femoral artery rupture due to radiotherapy for scrotal carcinoma. Acta Radiol Short Rep 2015; 4:2047981614545154. [PMID: 25610613 PMCID: PMC4299364 DOI: 10.1177/2047981614545154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 05/06/2014] [Accepted: 07/04/2014] [Indexed: 12/24/2022] Open
Abstract
We describe the case of a 72-year-old man with massive hemorrhage and shock resulting from rupture of the left common femoral artery as a complication of radiotherapy in the groin for cancer of the scrotum. This complication is extremely rare, presents dramatically, and is usually fatal. The patient was successfully treated with a stent graft deployment in order to achieve immediate hemostasis maintaining blood flow to the leg. Open surgery is not ideal in those cases especially when there is extensive tumor involvement of the groin causing altered anatomy and increasing the risk of re-bleeding.
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Affiliation(s)
- Umberto Marcello Bracale
- Department of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy
| | - Giovanni Merola
- Department of General Surgery, University Federico II of Naples, Naples, Italy
| | - Luca Del Guercio
- Department of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy
| | - Maurizio Sodo
- Department of General Surgery, University Federico II of Naples, Naples, Italy
| | - Anna Maria Giribono
- Department of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy
| | - Umberto Bracale
- Department of General Surgery, University Federico II of Naples, Naples, Italy
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Marsico F, Giugliano G, Ruggiero D, Parente A, Paolillo S, Guercio LD, Esposito G, Trimarco B, Filardi PP. Prevalence and severity of asymptomatic coronary and carotid artery disease in patients with abdominal aortic aneurysm. Angiology 2014; 66:360-4. [PMID: 24965380 DOI: 10.1177/0003319714540319] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We evaluated the prevalence and severity of occult coronary artery disease (CAD) and cerebrovascular disease (CeVD) in patients with abdominal aortic aneurysm (AAA). We studied 100 consecutive patients with no history of CAD, normal electrocardiogram, normal systolic function, and no angina or dyspnea. All patients underwent carotid Doppler study and invasive coronary angiography. Significant CAD was observed in 61% of patients. In all, 51% of patients with significant CAD showed either left main (n = 7), 3-vessel (n = 17), or proximal left anterior descending (n = 7) CAD, corresponding to 31% of the total cohort. Cerebrovascular disease was detected in 53% of patients, and in 38% of them was significant (peak systolic flow velocity ≥125 <230 cm/s). In 36% of patients with CeVD either left main (n = 5), 3-vessel (n = 11), or proximal left anterior descending (n = 3) CAD was observed. Severe asymptomatic CAD is prevalent in AAA, and 31% of patients fulfill indications for coronary revascularization.
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Affiliation(s)
- Fabio Marsico
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giuseppe Giugliano
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Donatella Ruggiero
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Antonio Parente
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Luca Del Guercio
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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Bracale UM, Corte G, Del Guercio L, Pecoraro F, Dinoto E, La Rosa G, Porcellini M, Bracale G, Bajardi G. Endovascular treatment of abdominal aortic anastomotic pseudoaneurysm. The experience of two centers. Ann Ital Chir 2012; 83:509-513. [PMID: 23110905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Abdominal aortic pseudoaneurysms are a rare but serious complication of aortic surgery. Treatment with traditional open surgery is associated with a high rate of perioperative mortality and morbidity. Endovascular treatment is less invasive and guarantees lower mortality and morbidity rates. The aim of this study was to evaluate the role of short-, medium- and long-term endovascular treatment of these pseudoaneurysms. MATERIALS AND METHODS Over the past 10 years, 14 patients with abdominal aortic aneurysms, which developed after prior aortic surgery, underwent endovascular treatment involving implantation of an endoprosthesis at our institutions. Exclusion criteria were emergency treatment and suspicion of an infected prosthesis. A Cheatham-platinum covered stent mounted on a balloon catheter was implanted in one patient and self-expandable stent-graft in the other 13. No fenestrated or custom-made prostheses were used. RESULTS The procedure had a 100% technical success rate. There was no postoperative mortality. Two type I endoleaks, observed at aortography at the end of the procedure, were not seen on the CT scan taken one month later. Three patients (21.4%) had major perioperative complications which consisted of early occlusion of a branch of the endoprosthesis, (treated with a femoro-femoral crossover bypass graft), a transient ischemic attack, and jaundice. The long-term mortality rate, at an average follow-up of 37.4 months, was 21.4%. None of the deaths was related to the procedure. CONCLUSIONS Endovascular treatment of patients who develop anastomotic pseudoaneurysm after surgery of the abdominal aorta is safe and effective both in the short and long term. In our opinion it is the treatment of choice for this category of patients.
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Fortunato G, Di Taranto MD, Bracale UM, Del Guercio L, Carbone F, Mazzaccara C, Morgante A, D’Armiento FP, D’Armiento M, Porcellini M, Sacchetti L, Bracale G, Salvatore F. Decreased Paraoxonase-2 Expression in Human Carotids During the Progression of Atherosclerosis. Arterioscler Thromb Vasc Biol 2008; 28:594-600. [DOI: 10.1161/atvbaha.107.154658] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Giuliana Fortunato
- From the Dipartimento di Biochimica e Biotecnologie Mediche (G.F., C.M., A.M., L.S., F.S.), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy and CEINGE scarl, Via Comunale Margherita 482, 80145 Napoli, Italy; Dipartimento Assistenziale di Chirurgia Generale Toracica, Vascolare e Endovascolare (U.M.B., L.D.G., F.C., M.P., G.B.), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy; Dipartimento di Scienze Biomorfologiche e
| | - Maria Donata Di Taranto
- From the Dipartimento di Biochimica e Biotecnologie Mediche (G.F., C.M., A.M., L.S., F.S.), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy and CEINGE scarl, Via Comunale Margherita 482, 80145 Napoli, Italy; Dipartimento Assistenziale di Chirurgia Generale Toracica, Vascolare e Endovascolare (U.M.B., L.D.G., F.C., M.P., G.B.), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy; Dipartimento di Scienze Biomorfologiche e
| | - Umberto Marcello Bracale
- From the Dipartimento di Biochimica e Biotecnologie Mediche (G.F., C.M., A.M., L.S., F.S.), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy and CEINGE scarl, Via Comunale Margherita 482, 80145 Napoli, Italy; Dipartimento Assistenziale di Chirurgia Generale Toracica, Vascolare e Endovascolare (U.M.B., L.D.G., F.C., M.P., G.B.), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy; Dipartimento di Scienze Biomorfologiche e
| | - Luca Del Guercio
- From the Dipartimento di Biochimica e Biotecnologie Mediche (G.F., C.M., A.M., L.S., F.S.), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy and CEINGE scarl, Via Comunale Margherita 482, 80145 Napoli, Italy; Dipartimento Assistenziale di Chirurgia Generale Toracica, Vascolare e Endovascolare (U.M.B., L.D.G., F.C., M.P., G.B.), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy; Dipartimento di Scienze Biomorfologiche e
| | - Francesca Carbone
- From the Dipartimento di Biochimica e Biotecnologie Mediche (G.F., C.M., A.M., L.S., F.S.), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy and CEINGE scarl, Via Comunale Margherita 482, 80145 Napoli, Italy; Dipartimento Assistenziale di Chirurgia Generale Toracica, Vascolare e Endovascolare (U.M.B., L.D.G., F.C., M.P., G.B.), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy; Dipartimento di Scienze Biomorfologiche e
| | - Cristina Mazzaccara
- From the Dipartimento di Biochimica e Biotecnologie Mediche (G.F., C.M., A.M., L.S., F.S.), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy and CEINGE scarl, Via Comunale Margherita 482, 80145 Napoli, Italy; Dipartimento Assistenziale di Chirurgia Generale Toracica, Vascolare e Endovascolare (U.M.B., L.D.G., F.C., M.P., G.B.), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy; Dipartimento di Scienze Biomorfologiche e
| | - Alberto Morgante
- From the Dipartimento di Biochimica e Biotecnologie Mediche (G.F., C.M., A.M., L.S., F.S.), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy and CEINGE scarl, Via Comunale Margherita 482, 80145 Napoli, Italy; Dipartimento Assistenziale di Chirurgia Generale Toracica, Vascolare e Endovascolare (U.M.B., L.D.G., F.C., M.P., G.B.), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy; Dipartimento di Scienze Biomorfologiche e
| | - Francesco Paolo D’Armiento
- From the Dipartimento di Biochimica e Biotecnologie Mediche (G.F., C.M., A.M., L.S., F.S.), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy and CEINGE scarl, Via Comunale Margherita 482, 80145 Napoli, Italy; Dipartimento Assistenziale di Chirurgia Generale Toracica, Vascolare e Endovascolare (U.M.B., L.D.G., F.C., M.P., G.B.), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy; Dipartimento di Scienze Biomorfologiche e
| | - Maria D’Armiento
- From the Dipartimento di Biochimica e Biotecnologie Mediche (G.F., C.M., A.M., L.S., F.S.), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy and CEINGE scarl, Via Comunale Margherita 482, 80145 Napoli, Italy; Dipartimento Assistenziale di Chirurgia Generale Toracica, Vascolare e Endovascolare (U.M.B., L.D.G., F.C., M.P., G.B.), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy; Dipartimento di Scienze Biomorfologiche e
| | - Massimo Porcellini
- From the Dipartimento di Biochimica e Biotecnologie Mediche (G.F., C.M., A.M., L.S., F.S.), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy and CEINGE scarl, Via Comunale Margherita 482, 80145 Napoli, Italy; Dipartimento Assistenziale di Chirurgia Generale Toracica, Vascolare e Endovascolare (U.M.B., L.D.G., F.C., M.P., G.B.), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy; Dipartimento di Scienze Biomorfologiche e
| | - Lucia Sacchetti
- From the Dipartimento di Biochimica e Biotecnologie Mediche (G.F., C.M., A.M., L.S., F.S.), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy and CEINGE scarl, Via Comunale Margherita 482, 80145 Napoli, Italy; Dipartimento Assistenziale di Chirurgia Generale Toracica, Vascolare e Endovascolare (U.M.B., L.D.G., F.C., M.P., G.B.), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy; Dipartimento di Scienze Biomorfologiche e
| | - Giancarlo Bracale
- From the Dipartimento di Biochimica e Biotecnologie Mediche (G.F., C.M., A.M., L.S., F.S.), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy and CEINGE scarl, Via Comunale Margherita 482, 80145 Napoli, Italy; Dipartimento Assistenziale di Chirurgia Generale Toracica, Vascolare e Endovascolare (U.M.B., L.D.G., F.C., M.P., G.B.), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy; Dipartimento di Scienze Biomorfologiche e
| | - Francesco Salvatore
- From the Dipartimento di Biochimica e Biotecnologie Mediche (G.F., C.M., A.M., L.S., F.S.), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy and CEINGE scarl, Via Comunale Margherita 482, 80145 Napoli, Italy; Dipartimento Assistenziale di Chirurgia Generale Toracica, Vascolare e Endovascolare (U.M.B., L.D.G., F.C., M.P., G.B.), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy; Dipartimento di Scienze Biomorfologiche e
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