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Pecoraro F, Volpe P, Boccalon L, Migliara B, Rivolta N, Silvestro A, Trabattoni PLM, Massara M, Diaco DA, Dinoto E, Urso F, Alberti A, Feriani G, Franchin M, Ravini ML, Saccu C. Outcome Analysis From a Multicenter Registry on Unibody Stent-Graft System for the Treatment of Spontaneous Infrarenal Acute Aortic Syndrome (MURUSSIAS Registry). J Endovasc Ther 2024; 31:232-240. [PMID: 36000341 DOI: 10.1177/15266028221118507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This study reports the outcomes from a Multicenter Registry on unibody stent-graft system for the treatment of spontaneous infrarenal acute aortic syndrome (MURUSSIAS registry). MATERIALS AND METHODS The retrospective MURUSSIAS registry included spontaneous infrarenal acute aortic dissection (IAAS) managed with the unibody stent-graft system (AFX endovascular AAA system; Endologix Inc., Irvine, California) outside the current instruction for use. IAAS considered aortic dissection (AD), intramural hematoma (IMH), and penetrating aortic ulcer (PAU). Indications to IAAS treatment were symptoms, associated dilated abdominal aorta (>3 cm), rapidly-growing (>0.5 cm/6 months) aorta, IAAS disease progression. Measured results were technical success, early (within 30 days) and midterm outcomes (after 30 days), including mortality, complications, symptoms recurrence, type I/III endoleak occurrence, stent-graft patency, survival, and freedom from reintervention. The mean follow-up was 22.12 ± 17 months. RESULTS The MURUSSIAS registry included 83 patients from 7 participating centers. IAAS indication to treatment were symptoms in 42 (51%). In 14 (17%) patients, the infrarenal aortic length was <80 mm, and in 28 (34%), the aortic bifurcation diameter was <16 mm. Technical success was 100%. Mortality occurred early in 1 (1%) and at the midterm in 3 (4%) patients. Complications occurred early in 10 (12%) patients (1 severe, 3 moderates, and 6 mild) and at midterm in 2 (2%) (2 moderate). No symptoms' recurrence or type I/III endoleaks were registered. The 36-month estimated survival and freedom from reinterventions were 89% and 92%, respectively. CONCLUSIONS The MURUSSIAS registry is the largest collection of spontaneous IAAS managed endovascularly using the AFX endovascular AAA system. The IAAS peculiar anatomic features were fitted with the used technique with excellent results. This treatment strategy might be considered in IAAS unless specifically-designed endovascular solutions will be available also in the emergent setting. Further studies are required to assess the longer-term performances and the stability of the reported technique. CLINICAL IMPACT The lack of specifically designed devices for infrarenal acute aortic syndrome (IAAS) disease remains an issue principally for its specific anatomic features. The MURUSSIAS registry retrospectively examined the outcomes of spontaneous IAAS treated using the unibody stent-graft system in a spontaneous national study; and reports the largest available data on this topic. The use of the unibody stent-graft system showed to fit the anatomic peculiarities of IAAS with excellent outcomes. This IAAS treatment strategy should be considered unless specifically designed endovascular solutions will be available.
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Affiliation(s)
- Felice Pecoraro
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- Vascular Surgery Unit, AOU Policlinico "P. Giaccone," Palermo, Italy
| | - Pietro Volpe
- Vascular and Endovascular Surgery Unit, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli," Reggio Calabria, Italy
| | - Luca Boccalon
- Vascular Surgery Unit, ASST Ospedale Maggiore Crema, Crema, Italy
| | - Bruno Migliara
- Vascular and Endovascular Surgery Unit, Pederzoli Hospital, Peschiera del Garda, VR, Italy
| | - Nicola Rivolta
- Vascular Surgery Unit, ASST-Settelaghi, Università degli studi dell'Insubria, Varese, Italy
| | - Antonino Silvestro
- Chirurgia Vascolare ed Endovascolare, ASST Rhodense, Garbagnate Milanese, Italy
| | - Piero L M Trabattoni
- Vascular and Endovascular Surgery Unit, Monzino Cardiology Centre, Milano, Italy
| | - Mafalda Massara
- Vascular and Endovascular Surgery Unit, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli," Reggio Calabria, Italy
| | - Domenico A Diaco
- Vascular Surgery Unit, ASST Ospedale Maggiore Crema, Crema, Italy
| | - Ettore Dinoto
- Vascular Surgery Unit, AOU Policlinico "P. Giaccone," Palermo, Italy
| | - Francesca Urso
- Vascular Surgery Unit, AOU Policlinico "P. Giaccone," Palermo, Italy
| | - Antonino Alberti
- Vascular and Endovascular Surgery Unit, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli," Reggio Calabria, Italy
| | - Giovanni Feriani
- Vascular and Endovascular Surgery Unit, Pederzoli Hospital, Peschiera del Garda, VR, Italy
| | - Marco Franchin
- Vascular Surgery Unit, ASST-Settelaghi, Università degli studi dell'Insubria, Varese, Italy
| | - Matteo L Ravini
- Chirurgia Vascolare ed Endovascolare, ASST Rhodense, Garbagnate Milanese, Italy
| | - Claudio Saccu
- Vascular and Endovascular Surgery Unit, Monzino Cardiology Centre, Milano, Italy
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De Pasquale L, Gobatti D, Ravini ML, Barassi A, Porreca W, Melzi d'Eril GV, Bastagli A. Intra-operative testing for parathyroid hormone: the Central Laboratory option. J Endocrinol Invest 2008; 31:62-7. [PMID: 18296907 DOI: 10.1007/bf03345568] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intra-operative PTH testing in the operating theatre has proven to be an accurate way to verify the removal of all pathological parathyroid tissue in primary hyperparathyroidism. Its limitation is the high cost. An alternative, more cost-effective procedure is proposed: intra-operative PTH dosage at the Central Laboratory. PATIENTS AND METHODS Fifty-four patients underwent parathyroidectomy with intraoperative dosage of PTH at the Central Laboratory. Three blood samples were taken from each patient: just after the induction of anesthesia, 5 and 10 min after parathyroidectomy. The samples were sent to the Central Laboratory and analysed simultaneously. The results were phoned back to the theatre. The procedure was considered effective when PTH drop was >/=50% from basal value, 10 min after parathyroidectomy. RESULTS 98.1% of patients proved recovered (average follow- up 31.1 months). The procedure had 3 false negatives, 1 false positive, with sensitivity, specificity, accuracy, positive predictive value and negative predictive value of 94.0%, 75.0%, 92.6%, 97.9%, and 50.0%, respectively. DISCUSSION AND CONCLUSION The main disadvantage of the presented procedure is the long waiting time. Nevertheless this time is the same as that required for results from intra-operative histological examination, the only alternative to determine surgery effectiveness in centres where portable instrumentation for intra-operative PTH dosage in the operating theatre is not available. The advantage of intra-operative PTH at the Central Laboratory is the very low cost. If results in terms of sensitivity, specificity, accuracy, and cost are taken into consideration, intra-operative dosage of PTH at the Central Laboratory may be deemed a viable alternative to the operating theatre.
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Affiliation(s)
- L De Pasquale
- Endocrine Surgery Unit, University of Milan, San Paolo Hospital, 20142 Milan, Italy.
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