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Piffaretti G, Franchin M, Gnesutta A, Gatta T, Piacentino F, Rivolta N, Lomazzi C, Bissacco D, Fontana F, Trimarchi S. Anatomic Feasibility of In-Situ Fenestration for Isolate Left Subclavian Artery Preservation during Thoracic Endovascular Aortic Repair Using an Adjustable Needle Puncturing System. J Clin Med 2023; 13:162. [PMID: 38202169 PMCID: PMC10779778 DOI: 10.3390/jcm13010162] [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: 10/24/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVES To evaluate the feasibility of thoracic endovascular aortic repair (TEVAR) using the Ankura™ device (Lifetech Scientific, Shenzhen, China) with left subclavian artery (LSA) in-situ fenestration (ISF) using an adjustable puncture device system. METHODS It is a single center, retrospective, financially unsupported cohort study of TEVAR performed from 16 February 2007 to 10 January 2023. Inclusion criteria were isolate LSA revascularization for elective or urgent/emergent "zone 2" TEVAR, and the availability of the preoperative computed tomography angiography. RESULTS Post-hoc analysis identified 52 TEVARs. There were 39 (75.0%) males, and 13 (25.0%) females: median age was 74.5 years (IQR, 65.5-78). Index TEVAR was performed for atherosclerotic aneurysm in 27 (51.9%) cases, dissection-related diseases in 18 (34.6%), penetrating aortic ulcer in 5 (9.6%), and blunt traumatic aortic injury in 2 (3.8%). Access-vessel feasibility rate of TEVAR using the Ankura™ device would have been 98.1% (51/52). Considering the morphology of the aortic arch, ISF TEVAR feasibility would have been 61.5% (32/52). Binary logistic regression analysis identified LSA angulation (OR: 1.1, 95%CI: 1.03-1.14, p = 0.003) to be associated with ISF feasibility using this endograft and a self-centering adjustable needle-based puncture device. CONCLUSIONS Potential feasibility of TEVAR using the Ankura™ endograft with ISF using a self-centering adjustable needle system was 61.5%. Left subclavian artery angulation seems to be the most important and limiting anatomical constraint.
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Affiliation(s)
- Gabriele Piffaretti
- Vascular Surgery—Department of Medicine and Surgery, University of Insubria School of Medicine, 21100 Varese, Italy; (M.F.); (N.R.)
- ASST Settelaghi University Teaching Hospital, 21100 Varese, Italy
| | - Marco Franchin
- Vascular Surgery—Department of Medicine and Surgery, University of Insubria School of Medicine, 21100 Varese, Italy; (M.F.); (N.R.)
- ASST Settelaghi University Teaching Hospital, 21100 Varese, Italy
| | - Aroa Gnesutta
- ASST Settelaghi University Teaching Hospital, 21100 Varese, Italy
| | - Tonia Gatta
- ASST Settelaghi University Teaching Hospital, 21100 Varese, Italy
| | - Filippo Piacentino
- ASST Settelaghi University Teaching Hospital, 21100 Varese, Italy
- Interventional Radiology—Department of Medicine and Surgery, University of Insubria School of Medicine, ASST Settelaghi University Teaching Hospital, 21100 Varese, Italy
| | - Nicola Rivolta
- Vascular Surgery—Department of Medicine and Surgery, University of Insubria School of Medicine, 21100 Varese, Italy; (M.F.); (N.R.)
- ASST Settelaghi University Teaching Hospital, 21100 Varese, Italy
| | - Chiara Lomazzi
- Vascular Surgery, Cardio Thoracic Vascular Department, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy (S.T.)
| | - Daniele Bissacco
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Federico Fontana
- ASST Settelaghi University Teaching Hospital, 21100 Varese, Italy
| | - Santi Trimarchi
- Vascular Surgery, Cardio Thoracic Vascular Department, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy (S.T.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
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Bissacco D, Mosti G, D'Oria M, Lomazzi C, Casana R, Morrison N, Caggiati A. Rationale and current evidence of aquatic exercise therapy in venous disease: A narrative review. Vascular 2023; 31:1026-1034. [PMID: 35586921 DOI: 10.1177/17085381221102783] [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
Chronic venous disorders (CVD) of the lower limbs can be treated with different strategies. Typically, conservative management is based on compression therapy, anticoagulants and venoactive drugs. Endovenous treatments remain the gold standard to treat saphenous insufficiency, with sclerotherapy and surgery maintaining a role in selected cases. In addition, several 'unconventional' approaches have been proposed to prevent CVD progression and complications, minimize symptoms and improve the quality of life and postoperative outcomes. Among these, balneotherapy and aquatic exercises are proving as valid and effective supporting treatments, as mentioned in a growing number of scientific publications. Moreover, aquatic protocols have been studied for both venous and lymphatic insufficiency. For these reasons, they were mentioned in the last CVD guidelines provided by the European Society for Vascular Surgery. The aim of this narrative review is to overview and summarize current literature evidences on the role and effectiveness of aquatic rehabilitative protocols in CVD, reviewing old and current literature. Furthermore, the physical basis of the effects of water immersion on lower limb venous and tissues modifications are also described.
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Affiliation(s)
- Daniele Bissacco
- Vascular Surgery Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Mosti
- Angiology Department, MD Barbantini Clinic, Lucca, Italy
| | - Mario D'Oria
- Vascular and Endovascular Surgery Unit, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Chiara Lomazzi
- Vascular Surgery Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Renato Casana
- Vascular Surgery Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Lomazzi C, Mandigers TJ, Gargiulo M, Mascoli C, Piffaretti G, Upchurch GR, Trimarchi S. Five-year sex-related outcomes of thoracic endovascular aortic repair in the Global Registry for Endovascular Aortic Treatment. J Vasc Surg 2023; 78:604-613.e4. [PMID: 37224892 DOI: 10.1016/j.jvs.2023.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The impact of sex on outcomes of thoracic endovascular aortic repair (TEVAR) represents an area of increased interest over the last decade, and long-term data are lacking. The aim of the present study was to investigate sex-related differences in long-term outcomes after TEVAR using real-world data from the Global Registry for Endovascular Aortic Treatment. METHODS Data were obtained retrospectively after querying the multicenter, sponsored Global Registry for Endovascular Aortic Treatment. Patients treated with TEVAR between December 2010 and January 2021 were selected regardless of the type of thoracic aortic disease. The primary outcome was sex-specific all-cause mortality at 5 years and maximum follow-up. Secondary outcomes were sex-specific all-cause mortality at 30 days and 1 year, and aorta-related mortality, major adverse cardiac events, neurological complications, and device-related complications or reinterventions at 30 days, 1 year, 5 years, and maximum follow-up. RESULTS A total of 805 patients were analyzed; 535 (66.5%) were males. Females were older (median, 66 years [interquartile range (IQR), 57-75 years] vs 69 years [IQR, 59-78 years], P < .001). Males had more frequently a history of coronary artery bypass grafting and renal insufficiency (8.7% vs 3.7% [P = .010] and 22.4% vs 11.6% [P < .001]). The median follow-up was 3.46 years (IQR, 1.49-4.99 years) for males and 3.18 years (IQR, 1.29-4.86 years) for females. Indications for TEVAR were mostly descending thoracic aortic aneurysms (n = 307 [38.1%]) type B aortic dissections (n = 250 [31.1%]) or others (n = 248 [30.8%]). Freedom from 5-year all-cause mortality was similar for males and females (67% [95% CI, 62.1-72.2] vs 65.9% [95% CI, 58.5-74.2]; P = .847), and there were no differences in secondary outcomes. Multivariable Cox regression showed females to have lower all-cause mortality rates; however, this difference did not reach statistical significance (hazard ratio, 0.97; 95% CI, 0.72-1.30; P = .834). Additional subgroup analyses based on the indication for TEVAR did not identify differences between both sexes for the primary and secondary outcomes except more endoleak type II in females with complicated type B aortic dissection (1.8% vs 12.1%; P = .023). CONCLUSIONS The present analysis suggests that long-term outcomes of TEVAR performed irrespective of the type of aortic disease are similar for males and females. Further studies are needed to clarify existing controversies regarding the impact of sex on outcomes of TEVAR.
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Affiliation(s)
- Chiara Lomazzi
- Section of Vascular Surgery, Cardio Thoracic Vascular Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tim J Mandigers
- Section of Vascular Surgery, Cardio Thoracic Vascular Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Mauro Gargiulo
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Sant'Orsola-Malpighi, Bologna, Italy
| | - Chiara Mascoli
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Sant'Orsola-Malpighi, Bologna, Italy
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | | | - Santi Trimarchi
- Section of Vascular Surgery, Cardio Thoracic Vascular Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Olsson KW, Mani K, Burdess A, Patterson S, Scali ST, Kölbel T, Panuccio G, Eleshra A, Bertoglio L, Ardita V, Melissano G, Acharya A, Bicknell C, Riga C, Gibbs R, Jenkins M, Bakthavatsalam A, Sweet MP, Kasprzak PM, Pfister K, Oikonomou K, Heloise T, Sobocinski J, Butt T, Dias N, Tang C, Cheng SWK, Vandenhaute S, Van Herzeele I, Sorber RA, Black JH, Tenorio ER, Oderich GS, Vincent Z, Khashram M, Eagleton MJ, Pedersen SF, Budtz-Lilly J, Lomazzi C, Bissacco D, Trimarchi S, Huerta A, Riambau V, Wanhainen A. Outcomes After Endovascular Aortic Intervention in Patients With Connective Tissue Disease. JAMA Surg 2023; 158:832-839. [PMID: 37314760 PMCID: PMC10267845 DOI: 10.1001/jamasurg.2023.2128] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/03/2023] [Indexed: 06/15/2023]
Abstract
IMPORTANCE Endovascular treatment is not recommended for aortic pathologies in patients with connective tissue diseases (CTDs) other than in redo operations and as bridging procedures in emergencies. However, recent developments in endovascular technology may challenge this dogma. OBJECTIVE To assess the midterm outcomes of endovascular aortic repair in patients with CTD. DESIGN, SETTING, AND PARTICIPANTS For this descriptive retrospective study, data on demographics, interventions, and short-term and midterm outcomes were collected from 18 aortic centers in Europe, Asia, North America, and New Zealand. Patients with CTD who had undergone endovascular aortic repair from 2005 to 2020 were included. Data were analyzed from December 2021 to November 2022. EXPOSURE All principal endovascular aortic repairs, including redo surgery and complex repairs of the aortic arch and visceral aorta. MAIN OUTCOMES AND MEASURES Short-term and midterm survival, rates of secondary procedures, and conversion to open repair. RESULTS In total, 171 patients were included: 142 with Marfan syndrome, 17 with Loeys-Dietz syndrome, and 12 with vascular Ehlers-Danlos syndrome (vEDS). Median (IQR) age was 49.9 years (37.9-59.0), and 107 patients (62.6%) were male. One hundred fifty-two (88.9%) were treated for aortic dissections and 19 (11.1%) for degenerative aneurysms. One hundred thirty-six patients (79.5%) had undergone open aortic surgery before the index endovascular repair. In 74 patients (43.3%), arch and/or visceral branches were included in the repair. Primary technical success was achieved in 168 patients (98.2%), and 30-day mortality was 2.9% (5 patients). Survival at 1 and 5 years was 96.2% and 80.6% for Marfan syndrome, 93.8% and 85.2% for Loeys-Dietz syndrome, and 75.0% and 43.8% for vEDS, respectively. After a median (IQR) follow-up of 4.7 years (1.9-9.2), 91 patients (53.2%) had undergone secondary procedures, of which 14 (8.2%) were open conversions. CONCLUSIONS AND RELEVANCE This study found that endovascular aortic interventions, including redo procedures and complex repairs of the aortic arch and visceral aorta, in patients with CTD had a high rate of early technical success, low perioperative mortality, and a midterm survival rate comparable with reports of open aortic surgery in patients with CTD. The rate of secondary procedures was high, but few patients required conversion to open repair. Improvements in devices and techniques, as well as ongoing follow-up, may result in endovascular treatment for patients with CTD being included in guideline recommendations.
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Affiliation(s)
| | - Kevin Mani
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anne Burdess
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Suzannah Patterson
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville
| | - Salvatore T. Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany
| | - Giuseppe Panuccio
- Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany
| | - Ahmed Eleshra
- Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany
| | - Luca Bertoglio
- Division of Vascular Surgery, Vita Salute San Raffaele University, San Raffaele Hospital, Milano, Italy
| | - Vincenzo Ardita
- Division of Vascular Surgery, Vita Salute San Raffaele University, San Raffaele Hospital, Milano, Italy
| | - Germano Melissano
- Division of Vascular Surgery, Vita Salute San Raffaele University, San Raffaele Hospital, Milano, Italy
| | - Amish Acharya
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Colin Bicknell
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Celia Riga
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Richard Gibbs
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Michael Jenkins
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Arvind Bakthavatsalam
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle
| | - Matthew P. Sweet
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle
| | - Piotr M. Kasprzak
- Department of Vascular and Endovascular Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Karin Pfister
- Department of Vascular and Endovascular Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Kyriakos Oikonomou
- Department of Vascular and Endovascular Surgery, University Medical Centre Regensburg, Regensburg, Germany
- Department of Vascular and Endovascular Surgery, Cardiovascular Surgery Clinic, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | - Tessely Heloise
- Department of Vascular Surgery, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Jonathan Sobocinski
- Department of Vascular Surgery, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Talha Butt
- Vascular Center, Skåne University Hospital and Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Nuno Dias
- Vascular Center, Skåne University Hospital and Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Ching Tang
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - Stephen W. K. Cheng
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Hong Kong, China
| | - Sarah Vandenhaute
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Rebecca A. Sorber
- Department of Vascular Surgery and Endovascular Therapy, Johns Hopkins Hospital, Baltimore, Maryland
| | - James H. Black
- Department of Vascular Surgery and Endovascular Therapy, Johns Hopkins Hospital, Baltimore, Maryland
| | - Emanuel R. Tenorio
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston
| | - Gustavo S. Oderich
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston
| | - Zoë Vincent
- Department of Vascular Surgery, Waikato Hospital, University of Auckland, Hamilton, New Zealand
| | - Manar Khashram
- Department of Vascular Surgery, Waikato Hospital, University of Auckland, Hamilton, New Zealand
| | - Matthew J. Eagleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Steen Fjord Pedersen
- Division of Vascular Surgery, Department of Cardiovascular Sugery, Aarhus University Hospital, Aarhus, Denmark
| | - Jacob Budtz-Lilly
- Division of Vascular Surgery, Department of Cardiovascular Sugery, Aarhus University Hospital, Aarhus, Denmark
| | - Chiara Lomazzi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Bissacco
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Santi Trimarchi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Abigail Huerta
- Vascular Surgery Department, CardioVascular Institute, Hospital Clinic, Barcelona, Spain
| | - Vincent Riambau
- Vascular Surgery Department, CardioVascular Institute, Hospital Clinic, Barcelona, Spain
| | - Anders Wanhainen
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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Bissacco D, Mandigers TJ, Romagnoli S, Aprea T, Lomazzi C, D'Alessio I, Ascenti V, Ierardi AM, Domanin M, Tolva VS, Carrafiello G, Trimarchi S. Acute venous problems: Integrating medical, surgical, and interventional treatments. Semin Vasc Surg 2023; 36:307-318. [PMID: 37330243 DOI: 10.1053/j.semvascsurg.2023.04.013] [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: 02/11/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 06/19/2023]
Abstract
"Acute venous problems" refers to a group of disorders that affect the veins and result in sudden and severe symptoms. They can be classified based on the pathological triggering mechanisms, such as thrombosis and/or mechanical compression, and their consequences, including symptoms, signs, and complications. The management and therapeutic approach depend on the severity of the disease, the location, and the involvement of the vein segment. Although summarizing these conditions can be challenging, the objective of this narrative review was to provide an overview of the most common acute venous problems. This will include an exhaustive yet concise and practical description of each condition. The multidisciplinary approach remains one of the major advantages in dealing with these conditions, maximizing the results and the prevention of complications.
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Affiliation(s)
- Daniele Bissacco
- Department of Clinical and Community Sciences, University of Milan, Via Sforza 35, 20122, Milan, Italy.
| | - Tim J Mandigers
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Romagnoli
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tiziana Aprea
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Lomazzi
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilenia D'Alessio
- Vascular Surgery Unit, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Velio Ascenti
- Postgraduate School of Radiology, University of Milan, Milan, Italy
| | - Anna Maria Ierardi
- Radiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Domanin
- Department of Clinical and Community Sciences, University of Milan, Via Sforza 35, 20122, Milan, Italy; Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Gianpaolo Carrafiello
- Radiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy
| | - Santi Trimarchi
- Department of Clinical and Community Sciences, University of Milan, Via Sforza 35, 20122, Milan, Italy; Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
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Mandigers TJ, Lomazzi C, Piffaretti G, Allievi S, Gargiulo M, Mascoli C, Trimarchi S. Gender Specific Outcomes of Thoracic Endovascular Aortic Repair: An Analysis from the Global Registry for Endovascular Aortic Treatment. J Vasc Surg 2023. [DOI: 10.1016/j.jvs.2023.01.082] [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: 03/17/2023]
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D'Oria M, Trimarchi S, Lomazzi C, Upchurch GR, Suominen V, Bissacco D, Taglialavoro J, Lepidi S. Incidence, predictors, and prognostic impact of in-hospital serious adverse events in patients ≥75 years of age undergoing elective endovascular aneurysm repair. Surgery 2023; 173:1093-1101. [PMID: 36526489 DOI: 10.1016/j.surg.2022.11.006] [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: 07/24/2022] [Revised: 10/26/2022] [Accepted: 11/13/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study sought to identify the factors associated with the occurrence of in-hospital serious adverse events after elective endovascular aortic repair (EVAR) in older patients within the Global Registry for Endovascular Aortic Treatment. METHODS Consecutive patients ages ≥75 years who received GORE EXCLUDER AAA Endoprosthesis (W.L. Gore & Associates, Inc, Flagstaff, AZ) for elective EVAR. Based on the age at index elective EVAR, patients were categorized into 3 groups for subsequent analyses: those ages 75 to 79, 80 to 84, and ≥85 years. The primary end points for this study were the incidence of serious adverse events and all-cause mortality. In-hospital complications were defined according to the International Organization for Standardization 14155 standard (https://www.iso.org/standard/71690.html) and considered serious adverse events if they led to any of the following: (1) a life-threatening illness or injury, (2) a permanent impairment of a body structure or a body function, (3) in-patient or prolonged hospitalization, or (4) medical or surgical intervention to prevent life-threatening illness or injury or permanent impairment to a body structure or a body function. RESULTS Overall, 1,333 older patients (ages 75-79: n = 601; 80-84: n = 474; and ≥85: n = 258) underwent elective EVAR in the Global Registry for Endovascular Aortic Treatment data set and were included in the present analysis. In total, 12 patients (0.9%) died perioperatively, and 103 patients (7.7%) experienced ≥1 in-hospital serious adverse event, with 18 patients (1.3%) experiencing >1 in-hospital complications. No significant differences were seen between the age groups in the rates of in-hospital serious adverse events (7.3% vs 8.2% vs 7.8%; P = .86). In logistic regression analysis, a history of chronic obstructive pulmonary disease (odds ratio = 2.014; 95% confidence interval, 1.215-3.340; P = .006) and prior requirement for dialysis (odds ratio = 4.655; 95% confidence interval, 1.087-19.928; P = .038) resulted as predictors for occurrence of in-hospital serious adverse events. In the whole cohort, the 5-year survival was 63% for patients who did not experience any in-hospital serious adverse events compared with 51% for those who experienced any complications (P = .003). Using multivariable Cox proportional hazards models, it was found that the occurrence of in-hospital serious adverse events (hazard ratio = 6.2; 95% confidence interval, 1.8-21.317; P = .003) and being underweight (hazard ratio = 7.0; 95% confidence interval, 1.371-35.783; P = .019) were the only independent predictors of death in ≤30 days from the initial intervention. Although age did not independently affect the risk for all-cause mortality in ≤180 days after the initial intervention, increasing age was associated with a higher risk for long-term death (ie, ≥181 days from index elective EVAR) in the multivariable analysis (ages 75-79: hazard ratio = 0.379; 95% confidence interval, 0.281-0.512; P < .001; and 80-84: hazard ratio = 0.562; 95% confidence interval, 0.419-0.754; P < .001). CONCLUSION After elective EVAR in older patients (ie, ≥75 years), the occurrence of in-hospital serious adverse events appears to increase the risk of death, particularly in ≤180 days after the initial elective EVAR intervention, and might be related to patient baseline characteristics, including history of pulmonary and renal disease.
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Affiliation(s)
- Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste, Italy.
| | - Santi Trimarchi
- Division of Vascular and Endovascular Surgery, IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Chiara Lomazzi
- Division of Vascular and Endovascular Surgery, IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Velipekka Suominen
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, and Tampere University, Faculty of Medicine and Life Sciences, Tampere, Finland
| | - Daniele Bissacco
- Division of Vascular and Endovascular Surgery, IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Jacopo Taglialavoro
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste, Italy
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste, Italy
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Bissacco D, Malloggi C, Domanin M, Lomazzi C, Tolva V, Odero A, Trimarchi S, Casana R. Risk factors for short and long-term great saphenous vein recanalization in patients treated with endovenous radiofrequency ablation. Vascular 2023; 31:131-141. [PMID: 34908508 DOI: 10.1177/17085381211058587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this retrospective single-center study is to describe and analyze short-, mid-, and long-term risk factors for great saphenous vein (GSV) recanalization after endovenous radiofrequency ablation (RFA). MATERIALS AND METHODS All consecutive patients with GSV incompetence and varicose veins underwent RFA were enrolled between 2009 and 2018. Data on demographic, pre- and postoperative color Doppler scan (CDUS) findings, perioperative complications, and follow-up were prospectively collected. Primary outcome was GSV recanalization rate at 1 week after RFA. Secondary outcomes were postoperative complication rate, as well as GSV recanalization rate at 1, 3, and 5 years after RFA. Risk factors for recanalization were also analyzed, for each follow-up assessment, identifying differences in recanalized (Rec) and non-recanalized (nRec) groups. RESULTS During the study period, 1297 patients were treated. Among these, 1265 had at least 1 week of follow-up. Mean follow-up time was 3.0 ± 1.9 years. Recanalization rate at 1 week, 1, 3, and 5 years was 2.4%, 4.3%, 9.3%, and 17.5%, respectively. After multivariate analysis for each follow-up evaluation, CEAP classes C4 and 5, as well as preoperative GSV diameter >6 mm and history of smoking were found to be independent predictors of recanalization. Furthermore, age >61 years and postoperative complications such as pigmentation, edema, and paresthesia were found to be dependent risk factors. CONCLUSION RFA remains a safe and durable technique to ablate incompetent GSV. Despite this, particular attention should be paid to patients with high CEAP classes to avoid short and long-term recanalization.
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Affiliation(s)
- Daniele Bissacco
- Vascular Surgery Unit, 9339IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Malloggi
- Laboratory of Research in Vascular Surgery, 9354IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Maurizio Domanin
- Vascular Surgery Unit, 9339IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical and Community Sciences, 9304Università degli Studi di Milano, Milan, Italy
| | - Chiara Lomazzi
- Vascular Surgery Unit, 9339IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valerio Tolva
- Vascular Surgery Unit, 9338ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Odero
- Department of Surgery, 9354IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Santi Trimarchi
- Vascular Surgery Unit, 9339IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical and Community Sciences, 9304Università degli Studi di Milano, Milan, Italy
| | - Renato Casana
- Laboratory of Research in Vascular Surgery, 9354IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Surgery, 9354IRCCS Istituto Auxologico Italiano, Milan, Italy
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9
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Mandigers TJ, Lomazzi C, Domanin M, Piffaretti G, van Herwaarden JA, Trimarchi S. Vascular Access Challenges in Thoracic Endovascular Aortic Repair: A Literature Review. Ann Vasc Surg 2022. [PMID: 37534575 DOI: 10.1016/j.avsg.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND This review aims to comprehensively summarize access challenges in thoracic endovascular aortic repair (TEVAR) by describing vascular access routes, associated risks, outcomes, and complications. METHODS A literature search was conducted utilizing the PubMed (Medline), Scopus, and Web of Science databases. Qualitative and quantitative data from selected studies are extracted and discussed according to available standards for narrative reviews. RESULTS In total, there were 109 eligible studies based on predefined inclusion- and exclusion criteria. There were 39 original articles or reviews and 57 case series or case reports. This article summarizes the evidence from these studies and discusses traditional retrograde access routes and techniques for TEVAR via a femoral or iliac route, with or without the use of conduits. Next, alternative antegrade access routes and techniques via a brachial, axillary, carotid, ascending aorta, transapical, transcaval, or another route are discussed. Vascular access complications are presented with specific attention to the importance of gender and alternative antegrade access routes. CONCLUSIONS Multiple access routes and techniques are currently available to overcome access challenges associated with TEVAR, based on low grade evidence from heterogeneous studies. Future research that compares different access routes and techniques might help in the development of a tailored access protocol for specific patients with challenging TEVAR access.
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10
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Mandigers TJ, Lomazzi C, Trimarchi S, Piffaretti G. The nature versus nurture debate continues for outcomes of thoracic endovascular aortic repair. J Card Surg 2022; 37:2324-2325. [PMID: 35488887 DOI: 10.1111/jocs.16577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Tim J Mandigers
- Department of Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherland
| | - Chiara Lomazzi
- Department of Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Santi Trimarchi
- Department of Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Clinical and Community Sciences Department, Università degli Studi di Milano, Milan, Italy
| | - Gabriele Piffaretti
- Vascular Surgery-Department of Medicine and Surgery, University of Insubria, Varese, Italy
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11
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Bissacco D, Malloggi C, Lomazzi C, Domanin M, Odero A, Trimarchi S, Casana R. Quality-of-life assessment in patients treated with radiofrequency ablation with or without great saphenous vein recanalization. Phlebology 2022; 37:223-225. [DOI: 10.1177/02683555211060622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Quality of life (QoL) in patients with chronic venous disorders has a central role to decide the correct treatment approach. In particular, in case of mini-invasive therapy, such as endovenous radiofrequency ablation (RFA), the postoperative QoL improvement remains one of the most important outcome to be reached. Despite this, very few data are published on the long-term QoL modifications after RFA. The aim of this brief report is to describe and analyze the role of QoL scales in a population of patients treated with RFA of the great saphenous vein and phlebectomies, highlighting results in short- and long-term follow-up period, and differences between recanalized and non-recanalized patients.
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Affiliation(s)
- Daniele Bissacco
- Vascular Surgery Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Malloggi
- Laboratory of Research in Vascular Surgery, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Chiara Lomazzi
- Vascular Surgery Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Domanin
- Vascular Surgery Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Andrea Odero
- Vascular Surgery Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Santi Trimarchi
- Vascular Surgery Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Renato Casana
- Laboratory of Research in Vascular Surgery, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Vascular Surgery Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
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12
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Bissacco D, Domanin M, Weaver FA, Azizzadeh A, Miller CC, Gable DR, Piffaretti G, Lomazzi C, Trimarchi S. Differences in Mid-Term Outcomes Between Patients Undergoing Thoracic Endovascular Aortic Repair for Aneurysm or Acute Aortic Syndromes: Report From the Global Registry for Endovascular Aortic Treatment. J Endovasc Ther 2021; 29:731-738. [PMID: 34911391 DOI: 10.1177/15266028211064819] [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] [Indexed: 11/15/2022]
Abstract
PURPOSE To analyze differences in baseline characteristics, overall mortality, device-related mortality, and re-intervention rates in patients who underwent thoracic endovascular aortic repair (TEVAR) for descending thoracic aortic aneurysm (DTAA) with atherosclerotic/degenerative cause or acute aortic syndrome (AAS), using the Global Registry For Endovascular Aortic Treatment (GREAT). MATERIALS AND METHODS Patients submitted to TEVAR for AAS or DTAA, included in GREAT, were eligible for this analysis. Primary outcome was 30-day all-cause mortality rate. Secondary outcomes were 30-day aorta-related mortality and re-intervention rate, 1-year and 3-year all-cause mortality, aorta-related mortality and re-intervention rate. RESULTS Five-hundred and seventy-five patients were analyzed (305 DTAA and 270 AAS). Thirty-day mortality rate was 1.3% and 1.8% for DTAA and AAS, respectively (p=0.741). One-year and 3-year mortality rates were 6.2% versus 9.3 and 17.3% versus 15.9% for DTAA and AAS, respectively (p=0.209 and p=0.655, respectively). Aorta-related mortality rates at 30 days, 1 year and 3 years were 1.3%, 1.3%, and 2.6% for DTAA, 1.8%, 4.2%, and 4.2% for AAS (p=ns). Re-intervention rates at 30 days, 1 year, and 3 years were 1.3%, 4.3%, and 7.5% for DTAA, 3.3%, 8.1%, and 10.7% for AAS (p=ns). Furthermore, a specific analysis with similar outcomes was performed dividing follow-up in 3 periods (1-30 days, 31-365 days, 366-1096 days) and describing mutual differences between 2 groups and temporal trends in each group. CONCLUSION Patients who underwent TEVAR for DTAA or AAS experienced different mortality and re-intervention rates among years during mid-term follow-up. Although all-cause related deaths within 30 days were TEVAR-related, aorta-related deaths were more common for AAS patients within 1 year. A greater re-intervention rate was described for AAS patients, although only 1 year after TEVAR.
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Affiliation(s)
- Daniele Bissacco
- Vascular Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Domanin
- Vascular Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Fred A Weaver
- Division of Vascular Surgery and Endovascular Therapy, University of Southern California, Los Angeles, CA, USA
| | - Ali Azizzadeh
- Division of Vascular Surgery, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Charles C Miller
- McGovern Medical School, Department of Cardiothoracic & Vascular Surgery, University of Texas Health Science Center, Houston, TX, USA
| | - Dennis R Gable
- Division of Vascular and Endovascular Surgery, Baylor Scott & White Heart Hospital, Plano, TX, USA
| | - Gabriele Piffaretti
- Vascular Surgery Unit, ASST Sette Laghi, Varese, Italy.,Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Chiara Lomazzi
- Vascular Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Santi Trimarchi
- Vascular Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
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13
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Katsarou M, Grassi V, Lomazzi C, Domanin M, Trimarchi S. Reply. J Vasc Surg 2021; 74:1772-1773. [PMID: 34688404 PMCID: PMC8526423 DOI: 10.1016/j.jvs.2021.07.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Maria Katsarou
- Section of Vascular Surgery, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Viviana Grassi
- Section of Vascular Surgery, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Lomazzi
- Section of Vascular Surgery, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Domanin
- Section of Vascular Surgery, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy, Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Santi Trimarchi
- Section of Vascular Surgery, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy, Department of Clinical and Community Sciences, University of Milan, Milan, Italy
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14
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Bissacco D, Lomazzi C, Buongiovanni G, Magni A, Domanin M, Casana R, Bismuth J, van Herwaarden JA, Upchurch GR, Trimarchi S. COVID-19 and aortic disease: a practical systematic review of the literature on management and outcomes. J Cardiovasc Surg (Torino) 2021; 62:527-534. [PMID: 34581554 DOI: 10.23736/s0021-9509.21.12049-x] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Since the advent of the 2019 coronavirus (COVID-19) outbreak, vascular specialists have faced dramatic changes in clinical and surgical practice. Although COVID-19 pulmonary signs and symptoms were the most pertinent problems initially, in the long term cardiovascular complications became the most fearsome, with poor outcomes in terms of morbidity and mortality. Algorithms and decision-making procedures have been modified, not only to treat new clinical findings in COVID-19 positive patients, but also to avoid complications related to pulmonary and systemic infections. Additionally, COVID-19 negative patients experienced challenging management, due to hospital crowding, the risk of nosocomial COVID-19 transmission, and pandemic emergencies. In this context, aortic interventions were subject to several difficulties. First, in COVID-19 positive patients, there was the onset of new pathological scenarios including thrombotic manifestations and the subsequent complications. Second, in both COVID-19 negative and positive patients, there was a need to deliver optimal treatment with acceptable perioperative risks, forcing a rethinking of decisionmaking especially in terms of indications for treatments. The aim of this systematic review is to present evidence published on COVID-19 and aortic-related issues, highlighting some challenging aspects regarding management, treatment and outcomes.
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Affiliation(s)
- Daniele Bissacco
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy -
| | - Chiara Lomazzi
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Agnese Magni
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Domanin
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Renato Casana
- Vascular Surgery Unit, IRCCS Auxologico, Milan, Italy
| | - Jean Bismuth
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | | | - Gilbert R Upchurch
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Santi Trimarchi
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
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15
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Grassi V, Trimarchi S, Weaver F, de Beaufort HWL, Azzizzadeh A, Upchurch GR, Piffaretti G, Lomazzi C. Endovascular repair of descending thoracic aortic aneurysms-a mid-term report from the Global Registry for Endovascular Aortic Treatment (GREAT). Eur J Cardiothorac Surg 2021; 61:357-364. [PMID: 34392333 DOI: 10.1093/ejcts/ezab366] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/09/2021] [Accepted: 07/18/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the short- to mid-term outcomes of descending thoracic aortic aneurysm (DTAA) repair from the Gore Global Registry for Endovascular Aortic Treatment (GREAT). METHODS This is a multicentre sponsored prospective observational cohort registry. The study population comprised those treated for DTAA receiving GORE thoracic aortic devices for DTAA repair between August 2010 and October 2016. Major primary outcomes were early and late survival, freedom from aorta-related mortality and freedom from aorta-related reintervention. RESULTS There were 180 (58.1%) males and 130 (41.9%) females: the mean age was 70 ± 11 years (range 18-92). The median maximum DTAA diameter was 60 mm (interquartile range 54-68.8). Technical success was achieved in all patients. Operative mortality, as well as immediate conversion to open repair, was never observed. At the 30-day window, mortality occurred in 4 (1.3%) patients, neurological events occurred in 4 (1.3%) patients (transient ischaemic attacks/stroke n = 3, paraplegia n = 1) and the reintervention rate was 4.5% (n = 14). Estimated survival was 95.6% [95% confidence interval (CI) 92.6-97.4] at 6 months, 92.7% (95% CI 89.1-95.2) at 1 year and 57.3% (95% CI 48.5-65.1) at 5 years. Freedom from aorta-related mortality was 98.3% (95% CI 96.1-99.3) at 6 months, 98.3% (95% CI 96.1-99.3) at 1 year and 92.2% (95% CI 83.4-96.4) at 5 years. Freedom from thoracic endovascular aortic repair (TEVAR)-related reintervention at 5 years was 87.2% (95% CI 81.2-91.4). CONCLUSIONS TEVAR for DTAAs using GORE thoracic aortic devices is associated with a low rate of device-related reinterventions and is effective at preventing aorta-related mortality for up to 5 years of follow-up. CLINICAL REGISTRATION NUMBER NCT number: NCT01658787. SUBJECT COLLECTION 161, 164.
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Affiliation(s)
- Viviana Grassi
- Vascular Surgery - Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Santi Trimarchi
- Vascular Surgery - Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Scienze Cliniche e di Comunità, University of Milan, Milan, Italy
| | - Fred Weaver
- USC Comprehensive Aortic Center, CardioVascular Thoracic Institute, Keck Medical Center of USC, Los Angeles, CA, USA
| | | | - Ali Azzizzadeh
- Vascular Surgery - Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Gilbert R Upchurch
- Vascular Surgery - Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Gabriele Piffaretti
- Vascular Surgery - Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Chiara Lomazzi
- Vascular Surgery - Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
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16
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Czerny M, Gottardi R, Puiu P, Bernecker OY, Citro R, Corte AD, di Marco L, Fink M, Gosslau Y, Haldenwang PL, Heijmen RH, Hugas-Mallorqui M, Iesu S, Jacobsen O, Jassar AS, Juraszek A, Kolowca M, Lepidi S, Marrocco-Trischitta MM, Matsuda H, Meisenbacher K, Micari A, Minatoya K, Park KH, Peterss S, Petrich M, Piffaretti G, Probst C, Reutersberg B, Rosati F, Schachner B, Schachner T, Sorokin VA, Szeberin Z, Szopinski P, Di Tommaso L, Trimarchi S, Verhoeven ELG, Vogt F, Voetsch A, Walter T, Weiss G, Yuan X, Benedetto F, De Bellis A, D'Oria M, Discher P, Zierer A, Rylski B, van den Berg JC, Wyss TR, Bossone E, Schmidli J, Nienaber C, Accarino G, Baldascino F, Böckler D, Corazzari C, D'Alessio I, de Beaufort H, De Troia C, Dumfarth J, Galbiati D, Gorgatti F, Hagl C, Hamiko M, Huber F, Hyhlik-Duerr A, Ianelli G, Iesu I, Jung JC, Kainz FM, Katsargyris A, Koter S, Kusmierczyk M, Kolsut P, Lengyel B, Lomazzi C, Muneretto C, Nava G, Nolte T, Pacini D, Pleban E, Rychla M, Sakamoto K, Shijo T, Yokawa K, Siepe M, Sirch J, Strauch J, Sule JA, Tobler EL, Walter C, Weigang E. Corrigendum to 'Impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with acute and chronic aortic conditions'. Eur J Cardiothorac Surg 2021; 60:724-725. [PMID: 34378028 PMCID: PMC8385948 DOI: 10.1093/ejcts/ezab314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Martin Czerny
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Roman Gottardi
- Department of Cardiovascular and Thoracic Surgery, MediClin Heart Institute Lahr/Baden, Lahr, Germany.,Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Paul Puiu
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Oliver Y Bernecker
- Department of Cardiac Surgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Rodolfo Citro
- Cardiology Unit, University Hospital San Giovanni di Dio e Ruggi d_Aragona, Salerno, Italy
| | - Alessandro Della Corte
- Cardiac Surgery Unit, Department of Translational Medical Sciences, University of Campania "L.Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Luca di Marco
- Department of Cardiac Surgery, Hospital Santa Orsola, University of Bologna, Bologna, Italy
| | - Martina Fink
- Department of Vascular Surgery, HGZ Bad Bevensen, Bad Bevensen, Germany
| | - Yvonne Gosslau
- Department for Vascular and Endovascular Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Peter Lukas Haldenwang
- Department of Cardiothoracic Surgery, University Hospital Bergmannsheil Bochum, Ruhr University of Bochum, Bochum, Germany
| | - Robin H Heijmen
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Maria Hugas-Mallorqui
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Severino Iesu
- Cardiac Surgery Unit, University Hospital San Giovanni di Dio e Ruggi d_Aragona, Salerno, Italy
| | - Oyvind Jacobsen
- Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway, Oslo, Norway
| | - Arminder S Jassar
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrzej Juraszek
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Maciej Kolowca
- Cardiac Surgery Department, University State Hospital No 2, University of Rzesznow, Rzesznow, Poland
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste Medical School, Trieste, Italy
| | | | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Katrin Meisenbacher
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kay-Hyun Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sven Peterss
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Michael Petrich
- Department of Vascular and Endovascular Surgery, Hubertus Hospital Berlin, Berlin, Germany
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Medicine and Surgery, University of Insubria, School of Medicine and ASST Settelaghi University Teaching Hospital, Varese, Italy
| | - Chris Probst
- Department of Cardiac Surgery, University of Bonn, Bonn, Germany
| | - Benedikt Reutersberg
- Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Fabrizio Rosati
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | - Bruno Schachner
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Thomas Schachner
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Vitaly A Sorokin
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, National University Health System, Singapore
| | - Zoltan Szeberin
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Piotr Szopinski
- Department of Vascular Surgery, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Luigi Di Tommaso
- Department of Cardiac Surgery, School of Medicine, University Federico II, Naples, Italy
| | - Santi Trimarchi
- Unita Operativa di Chirurgia Vascolare, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Eric L G Verhoeven
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Ferdinand Vogt
- Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Andreas Voetsch
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Tim Walter
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | | | - Xun Yuan
- Cardiology and Aortic Centre, The Royal Brompton & Harefield NHS Foundation Trust; National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, London, UK
| | | | - Antonio De Bellis
- Cardiac Surgery Unit, Heart and Vessels Department, Casa di Cura San Michele, Maddaloni, Italy
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste Medical School, Trieste, Italy
| | - Philipp Discher
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Andreas Zierer
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Bartosz Rylski
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Jos C van den Berg
- Centro Vasolare Ticino, Ospedale Regionale di Lugano, Lugano, Switzerland.,Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas R Wyss
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Vascular Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Jürg Schmidli
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Nienaber
- Cardiology and Aortic Centre, The Royal Brompton & Harefield NHS Foundation Trust; National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, London, UK
| | | | - Giulio Accarino
- Cardiac Surgery Unit, University Hospital San Giovanni di Dio e Ruggi d_Aragona, Salerno, Italy
| | | | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Claudio Corazzari
- Department of Cardiac Surgery, Department of Medicine and Surgery, University of Insubria, School of Medicine and ASST Settelaghi University Teaching, Hospital, Varese, Italy
| | - Ilenia D'Alessio
- Unita Operativa di Chirurgia Vascolare, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Hector de Beaufort
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | | | - Julia Dumfarth
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Denise Galbiati
- Cardiac Surgery Unit, Department of Translational Medical Sciences, University of Campania "L.Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Filippo Gorgatti
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste Medical School, Trieste, Italy
| | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Marwan Hamiko
- Department of Cardiac Surgery, University of Bonn, Bonn, Germany
| | - Florian Huber
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Alexander Hyhlik-Duerr
- Department for Vascular and Endovascular Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Gabriele Ianelli
- Department of Cardiac Surgery, School of Medicine, University Federico II, Naples, Italy
| | - Ivana Iesu
- Cardiology Unit, University Hospital San Giovanni di Dio e Ruggi d_Aragona, Salerno, Italy
| | - Joon-Chui Jung
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Frieda-Maria Kainz
- Department of Cardiac Surgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Athanasios Katsargyris
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Stephan Koter
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Mariusz Kusmierczyk
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Piotr Kolsut
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Balazs Lengyel
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Chiara Lomazzi
- Unita Operativa di Chirurgia Vascolare, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Claudio Muneretto
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | - Giovanni Nava
- Cardiovascular Department, IRCCS-Policlinico San Donato, Milan, Italy
| | - Thomas Nolte
- Department of Vascular Surgery, HGZ Bad Bevensen, Bad Bevensen, Germany
| | - Davide Pacini
- Department of Cardiac Surgery, Hospital Santa Orsola, University of Bologna, Bologna, Italy
| | - Eliza Pleban
- Department of Vascular Surgery, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Miriam Rychla
- Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Kazuhisa Sakamoto
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takayuki Shijo
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Koki Yokawa
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Matthias Siepe
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Joachim Sirch
- Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, University Hospital Bergmannsheil Bochum, Ruhr University of Bochum, Bochum, Germany
| | - Jai Ajitchandra Sule
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, National University Health System, Singapore
| | - Eva-Luca Tobler
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Ernst Weigang
- Department of Vascular and Endovascular Surgery, Hubertus Hospital Berlin, Berlin, Germany
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17
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Piffaretti G, Czerny M, Riambau V, Gottardi R, Wolfgruber T, Probst C, Matt P, Antonello M, Gerosa G, Hamady M, Fontana F, Ferrarese S, Lomazzi C, Grassi V, Fernandez-Alonso S, Trimarchi S. Endovascular repair of ascending aortic diseases with custom-made endografts. Eur J Cardiothorac Surg 2021; 59:741-749. [PMID: 33394032 DOI: 10.1093/ejcts/ezaa383] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 04/21/2020] [Revised: 08/28/2020] [Accepted: 09/15/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The aim of this article is to report the mid-term results of ascending thoracic endovascular aortic repair using a custom-made device (CMD). METHODS This was a retrospective study performed at tertiary centres. Nine patients considered unfit for open surgery received elective total endovascular repair of the ascending aorta with a Relay® (Terumo Aortic, Sunrise; FL, USA) CMD: pseudoaneurysn (n = 5), localized dissection (n =3) and contained rupture (n = 1). RESULTS Primary clinical success was achieved in all patients with no major complications and no early conversion to open surgery. All patients were discharged home and independent: median length of stay was 7 days (interquartile range, 6-18). No patient was lost to follow-up at a median 26 months (interquartile range, 12-36). Three patients died 2, 6 and 24 months after intervention; 1 was aorta related (late aorto-atrial fistula due to infection that required open surgery). At the last follow-up available, no endoleaks, migrations, fractures or ruptures were observed in the remaining 6 patients. CONCLUSIONS Ascending thoracic endovascular aortic repair with Terumo Aortic CMDs was technically feasible, effective and safe in very selected lesions. CMDs showed good ascending aorta conformability with different configurations and diameters, and satisfactory mid-term durability as shown by both structural integrity and aortic lesion exclusion.
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Affiliation(s)
- Gabriele Piffaretti
- Vascular Surgery-Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Martin Czerny
- Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Vicente Riambau
- Vascular Surgery Division, Cardiovascular Institute, Hospital Clinic University of Barcelona, Barcelona, Spain
| | - Roman Gottardi
- Department of Cardiac Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Wolfgruber
- Department of Cardiac Surgery, Paracelsus Medical University, Salzburg, Austria.,Department of Radiology, Paracelsus Medical University, Salzburg, Austria
| | - Chris Probst
- Department of Cardiac Surgery, University of Bonn, Bonn, Germany
| | - Peter Matt
- Department of Cardiac Surgery, Herzzentrum Luzern, Luzern, Switzerland
| | - Michele Antonello
- Vascular and Cardiac Surgery-Department of Cardiac, Thoracic and Vascular Sciences, University of Padua School of Medicine, Padua, Italy
| | - Gino Gerosa
- Vascular and Cardiac Surgery-Department of Cardiac, Thoracic and Vascular Sciences, University of Padua School of Medicine, Padua, Italy
| | - Mohamad Hamady
- Interventional Radiology-Department of Surgery and Cancer, St Mary's Hospital Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Federico Fontana
- Interventional Radiology-Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Sandro Ferrarese
- Vascular Surgery-Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy.,Cardiac Surgery-Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Chiara Lomazzi
- Vascular Surgery, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Viviana Grassi
- Vascular Surgery, Fondazione IRCCS Cà Granda, Milan, Italy
| | | | - Santi Trimarchi
- Vascular Surgery, Fondazione IRCCS Cà Granda, Milan, Italy.,Department of Clinical and Community Sciences, Ospedale Maggiore Policlinico, Milan, Italy
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18
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Czerny M, Gottardi R, Puiu P, Bernecker OY, Citro R, Della Corte A, di Marco L, Fink M, Gosslau Y, Haldenwang PL, Heijmen RH, Hugas-Mallorqui M, Iesu S, Jacobsen O, Jassar AS, Juraszek A, Kolowca M, Lepidi S, Marrocco-Trischitta MM, Matsuda H, Meisenbacher K, Micari A, Minatoya K, Park KH, Peterss S, Petrich M, Piffaretti G, Probst C, Reutersberg B, Rosati F, Schachner B, Schachner T, Sorokin VA, Szeberin Z, Szopinski P, Di Tommaso L, Trimarchi S, Verhoeven ELG, Vogt F, Voetsch A, Walter T, Weiss G, Yuan X, Benedetto F, De Bellis A, D Oria M, Discher P, Zierer A, Rylski B, van den Berg JC, Wyss TR, Bossone E, Schmidli J, Nienaber C, Accarino G, Baldascino F, Böckler D, Corazzari C, D Alessio I, de Beaufort H, De Troia C, Dumfarth J, Galbiati D, Gorgatti F, Hagl C, Hamiko M, Huber F, Hyhlik-Duerr A, Ianelli G, Iesu I, Jung JC, Kainz FM, Katsargyris A, Koter S, Kusmierczyk M, Kolsut P, Lengyel B, Lomazzi C, Muneretto C, Nava G, Nolte T, Pacini D, Pleban E, Rychla M, Sakamoto K, Shijo T, Yokawa K, Siepe M, Sirch J, Strauch J, Sule JA, Tobler EL, Walter C, Weigang E. Impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with acute and chronic aortic conditions. Eur J Cardiothorac Surg 2021; 59:1096-1102. [PMID: 33394040 PMCID: PMC7799089 DOI: 10.1093/ejcts/ezaa452] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/30/2020] [Accepted: 11/16/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on acute and elective thoracic and abdominal aortic procedures. METHODS Forty departments shared their data on acute and elective thoracic and abdominal aortic procedures between January and May 2020 and January and May 2019 in Europe, Asia and the USA. Admission rates as well as delay from onset of symptoms to referral were compared. RESULTS No differences in the number of acute thoracic and abdominal aortic procedures were observed between 2020 and the reference period in 2019 [incidence rates ratio (IRR): 0.96, confidence interval (CI) 0.89-1.04; P = 0.39]. Also, no difference in the time interval from acute onset of symptoms to referral was recorded (<12 h 32% vs > 12 h 68% in 2020, < 12 h 34% vs > 12 h 66% in 2019 P = 0.29). Conversely, a decline of 35% in elective procedures was seen (IRR: 0.81, CI 0.76-0.87; P < 0.001) with substantial differences between countries and the most pronounced decline in Italy (-40%, P < 0.001). Interestingly, in Switzerland, an increase in the number of elective cases was observed (+35%, P = 0.02). CONCLUSIONS There was no change in the number of acute thoracic and abdominal aortic cases and procedures during the initial wave of the COVID-19 pandemic, whereas the case load of elective operations and procedures decreased significantly. Patients with acute aortic syndromes presented despite COVID-19 and were managed according to current guidelines. Further analysis is required to prove that deferral of elective cases had no impact on premature mortality.
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Affiliation(s)
- Martin Czerny
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Roman Gottardi
- Department of Cardiovascular and Thoracic Surgery, MediClin Heart Institute Lahr/Baden, Lahr, Germany.,Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Paul Puiu
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Oliver Y Bernecker
- Department of Cardiac Surgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Rodolfo Citro
- Cardiology Unit, University Hospital San Giovanni di Dio e Ruggi d´Aragona, Salerno, Italy
| | - Alessandro Della Corte
- Cardiac Surgery Unit, Department of Translational Medical Sciences, University of Campania "L.Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Luca di Marco
- Department of Cardiac Surgery, Hospital Santa Orsola, University of Bologna, Bologna, Italy
| | - Martina Fink
- Department of Vascular Surgery, HGZ Bad Bevensen, Bad Bevensen, Germany
| | - Yvonne Gosslau
- Department for Vascular and Endovascular Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Peter Lukas Haldenwang
- Department of Cardiothoracic Surgery, University Hospital Bergmannsheil Bochum, Ruhr University of Bochum, Bochum, Germany
| | - Robin H Heijmen
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Maria Hugas-Mallorqui
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Severino Iesu
- Cardiac Surgery Unit, University Hospital San Giovanni di Dio e Ruggi d´Aragona, Salerno, Italy
| | - Oyvind Jacobsen
- Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway, Oslo, Norway
| | - Arminder S Jassar
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrzej Juraszek
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Maciej Kolowca
- Cardiac Surgery Department, University State Hospital No 2, University of Rzesznow, Rzesznow, Poland
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste Medical School, Trieste, Italy
| | | | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Katrin Meisenbacher
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kay-Hyun Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sven Peterss
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Michael Petrich
- Department of Vascular and Endovascular Surgery, Hubertus Hospital Berlin, Berlin, Germany
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Medicine and Surgery, University of Insubria, School of Medicine and ASST Settelaghi University Teaching Hospital, Varese, Italy
| | - Chris Probst
- Department of Cardiac Surgery, University of Bonn, Bonn, Germany
| | - Benedikt Reutersberg
- Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Fabrizio Rosati
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | - Bruno Schachner
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Thomas Schachner
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Vitali A Sorokin
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, National University Health System, Singapore
| | - Zoltan Szeberin
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Piotr Szopinski
- Department of Vascular Surgery, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Luigi Di Tommaso
- Department of Cardiac Surgery, School of Medicine, University Federico II, Naples, Italy
| | - Santi Trimarchi
- Unita Operativa di Chirurgia Vascolare, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Eric L G Verhoeven
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Ferdinand Vogt
- Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Andreas Voetsch
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Tim Walter
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | | | - Xun Yuan
- Cardiology and Aortic Centre, The Royal Brompton & Harefield NHS Foundation Trust; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | | | - Antonio De Bellis
- Cardiac Surgery Unit, Heart and Vessels Department, Casa di Cura San Michele, Maddaloni, Italy
| | - Mario D Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste Medical School, Trieste, Italy
| | - Philipp Discher
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Andreas Zierer
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Bartosz Rylski
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Jos C van den Berg
- Centro Vasolare Ticino, Ospedale Regionale di Lugano, Lugano, Switzerland.,Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas R Wyss
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Vascular Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Jürg Schmidli
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Nienaber
- Cardiology and Aortic Centre, The Royal Brompton & Harefield NHS Foundation Trust; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | | | - Giulio Accarino
- Cardiac Surgery Unit, University Hospital San Giovanni di Dio e Ruggi d´Aragona, Salerno, Italy
| | | | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Claudio Corazzari
- Department of Cardiac Surgery, Department of Medicine and Surgery, University of Insubria, School of Medicine and ASST Settelaghi University Teaching Hospital, Varese, Italy
| | - Ilenia D Alessio
- Unita Operativa di Chirurgia Vascolare, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Hector de Beaufort
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | | | - Julia Dumfarth
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Denise Galbiati
- Cardiac Surgery Unit, Department of Translational Medical Sciences, University of Campania "L.Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Filippo Gorgatti
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste Medical School, Trieste, Italy
| | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Marwan Hamiko
- Department of Cardiac Surgery, University of Bonn, Bonn, Germany
| | - Florian Huber
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Alexander Hyhlik-Duerr
- Department for Vascular and Endovascular Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Gabriele Ianelli
- Department of Cardiac Surgery, School of Medicine, University Federico II, Naples, Italy
| | - Ivana Iesu
- Cardiology Unit, University Hospital San Giovanni di Dio e Ruggi d´Aragona, Salerno, Italy
| | - Joon-Chui Jung
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Frieda-Maria Kainz
- Department of Cardiac Surgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Athanasios Katsargyris
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Stephan Koter
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Mariusz Kusmierczyk
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Piotr Kolsut
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Balazs Lengyel
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Chiara Lomazzi
- Unita Operativa di Chirurgia Vascolare, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Claudio Muneretto
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | - Giovanni Nava
- Cardiovascular Department, IRCCS-Policlinico San Donato, Milan, Italy
| | - Thomas Nolte
- Department of Vascular Surgery, HGZ Bad Bevensen, Bad Bevensen, Germany
| | - Davide Pacini
- Department of Cardiac Surgery, Hospital Santa Orsola, University of Bologna, Bologna, Italy
| | - Eliza Pleban
- Department of Vascular Surgery, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Miriam Rychla
- Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Kazuhisa Sakamoto
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takayuki Shijo
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Koki Yokawa
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Matthias Siepe
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Joachim Sirch
- Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, University Hospital Bergmannsheil Bochum, Ruhr University of Bochum, Bochum, Germany
| | - Jai Ajitchandra Sule
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, National University Health System, Singapore
| | - Eva-Luca Tobler
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Ernst Weigang
- Department of Vascular and Endovascular Surgery, Hubertus Hospital Berlin, Berlin, Germany
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19
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Lomazzi C, Bissacco D, Logan MS, Grassi V, Piffaretti G, Trimarchi S, L Bush R. Risk factors for saphenous vein recanalization after endovenous radiofrequency ablation. J Cardiovasc Surg (Torino) 2021; 62:427-434. [PMID: 34014061 DOI: 10.23736/s0021-9509.21.11908-1] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Target vein recanalization is defined as the postoperative detection of blood flow in a venous segment previously ablated. It can be occurred after thermal-tumescent procedures, as radiofrequency (RFA) and endovenous laser (EVLA) ablation techniques. Despite several papers described and analyzed incidence and consequences of recanalization, limited data are published on risk factors for this condition. The aim of this general review is to investigate clinical and instrumental risk factors for great and small saphenous veins recanalization after RFA, indicating their impact in the follow-up period.
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Affiliation(s)
- Chiara Lomazzi
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy -
| | - Daniele Bissacco
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Viviana Grassi
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gabriele Piffaretti
- Vascular Surgery Unit, ASST Settelaghi University Teaching Hospital, Varese, Italy.,Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Santi Trimarchi
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Ruth L Bush
- University of Houston College of Medicine, Houston, TX, USA
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20
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Trimarchi S, Bissacco D, Lomazzi C, Domanin M. The best in the whole. Eur J Cardiothorac Surg 2021; 60:660-661. [PMID: 33954586 DOI: 10.1093/ejcts/ezab236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/01/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Santi Trimarchi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Vascular Surgery Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Bissacco
- Vascular Surgery Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Lomazzi
- Vascular Surgery Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Domanin
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Vascular Surgery Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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21
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Franchin M, Grassi V, Piffaretti G, Bush R, Tozzi M, Lomazzi C. Thoracic Endovascular Aortic Repair in “Shaggy Thoracic Aortic Aneurysms”. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2020.11.005] [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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22
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Lomazzi C, Trimarchi S. Local and Not Crucial Issue Needs To Interest the Global Community? Eur J Vasc Endovasc Surg 2020; 61:422. [PMID: 33358459 DOI: 10.1016/j.ejvs.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/17/2020] [Accepted: 12/03/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Chiara Lomazzi
- Vascular Surgery, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Santi Trimarchi
- Vascular Surgery, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical and Community Sciences, University of Milan, Milan, Italy.
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Katsarou M, Grassi V, Lomazzi C, Domanin M, Trimarchi S. Acute retrograde type A intramural hematoma during severe acute respiratory syndrome coronavirus 2 pandemic. J Vasc Surg 2020; 73:2166-2167. [PMID: 33068766 PMCID: PMC7558231 DOI: 10.1016/j.jvs.2020.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/11/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Maria Katsarou
- Section of Vascular Surgery, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Viviana Grassi
- Section of Vascular Surgery, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Lomazzi
- Section of Vascular Surgery, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Domanin
- Section of Vascular Surgery, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Santi Trimarchi
- Section of Vascular Surgery, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical and Community Sciences, University of Milan, Milan, Italy.
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24
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Trimarchi S, Grassi V, Lomazzi C, Domanin M, Bissacco D, Bellosta R, Piffaretti G. Endovascular type A aortic repair-When? J Card Surg 2020; 36:1742-1744. [PMID: 33029800 DOI: 10.1111/jocs.15103] [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: 07/16/2020] [Revised: 09/10/2020] [Accepted: 09/24/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Santi Trimarchi
- Department of Surgery, Vascular Surgery, Ospedale Maggiore Policlinico, Fondazione IRCCS Cà Granda, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan School of Medicine, Milan, Italy
| | - Viviana Grassi
- Department of Surgery, Vascular Surgery, Ospedale Maggiore Policlinico, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Chiara Lomazzi
- Department of Surgery, Vascular Surgery, Ospedale Maggiore Policlinico, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Maurizio Domanin
- Department of Surgery, Vascular Surgery, Ospedale Maggiore Policlinico, Fondazione IRCCS Cà Granda, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan School of Medicine, Milan, Italy
| | - Daniele Bissacco
- Department of Surgery, Vascular Surgery, Ospedale Maggiore Policlinico, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Raffaello Bellosta
- Vascular Surgery, Cardiovascular Department, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
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25
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Bissacco D, Lomazzi C, Trimarchi S. Take a look a little bit over: Femoral valve and lower limb venous disease. Vascular 2020; 29:472-473. [PMID: 33019913 DOI: 10.1177/1708538120961692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Daniele Bissacco
- Vascular Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Lomazzi
- Vascular Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Santi Trimarchi
- Vascular Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
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26
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Bissacco D, Grassi V, Lomazzi C, Domanin M, Bellosta R, Piffaretti G, Trimarchi S. Is there a vascular side of the story? Vascular consequences during COVID-19 outbreak in Lombardy, Italy. J Card Surg 2020; 36:1677-1682. [PMID: 33012015 PMCID: PMC7675479 DOI: 10.1111/jocs.15069] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 06/30/2020] [Revised: 08/24/2020] [Accepted: 09/06/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lombardy, in the northern Italy, was one of the most affected region in the world by novel coronavirus COVID-19 outbreak. Due to the dramatic amount of confirmed positive cases and deaths, all clinical and surgical hospital departments changed their daily activities to face emergent pandemic situations. In particular, vascular surgery units reorganized their role and priorities for both elective and urgent patients requiring open or endovascular interventions. MATERIAL & METHODS This brief review summarizes organization of vascular Lombardy centers network adopted during pandemic period and clinical evidences published so far by regional referral and nonreferral hospitals in terms of vascular surgery and medicine implications in COVID-19 positive or negative patients managements. RESULTS Different patterns of disease were described during phase 1 COVID-19 outbreak in Lombardy region, with major attention in pheriperal artery disease and venous thrombosis. CONCLUSION COVID-19 infection seems to be not only a pulmonary but also a vascular (arterial and venous) disease. Further study are necessary to described mid and long-term outcomes in COVID-19 vascular patients population.
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Affiliation(s)
- Daniele Bissacco
- Vascular Surgery Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Viviana Grassi
- Vascular Surgery Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Lomazzi
- Vascular Surgery Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Domanin
- Vascular Surgery Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Raffaello Bellosta
- Division of Vascular Surgery, Department of Cardiovascular Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Gabriele Piffaretti
- Department of Medicine and Surgery, University of Insubria School of Medicine and ASST Settelaghi, Varese, Italy
| | - Santi Trimarchi
- Vascular Surgery Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
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Lomazzi C, Mascoli C, de Beaufort H, Cao P, Weaver F, Milner R, Fillinger M, Verhoeven E, Grassi V, Gargiulo M, Trimarchi S, Piffaretti G. Gender Related Access Complications After TEVAR: Analysis from the Retrospective Multicentre Cohort GORE® GREAT Registry Study. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.07.052] [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: 10/23/2022]
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28
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Lomazzi C, Mascoli C, de Beaufort HW, Cao P, Weaver F, Milner R, Fillinger M, Verhoeven E, Grassi V, Gargiulo M, Trimarchi S, Piffaretti G. Gender Related Access Complications After TEVAR: Analysis from the Retrospective Multicentre Cohort GORE® GREAT Registry Study. Eur J Vasc Endovasc Surg 2020; 60:203-209. [DOI: 10.1016/j.ejvs.2020.04.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 03/14/2020] [Accepted: 04/09/2020] [Indexed: 11/16/2022]
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Piffaretti G, Trimarchi S, Gelpi G, Romagnoni C, Ferrarese S, Tozzi M, Bush RL, Lomazzi C. Hybrid repair of extensive thoracic aortic aneurysms. Eur J Cardiothorac Surg 2020; 58:940-948. [DOI: 10.1093/ejcts/ezaa178] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 11/12/2022] Open
Abstract
Abstract
OBJECTIVES
Our goal was to report the midterm results of hybrid treatment of extensive thoracic aortic aneurysm (ETAA) with the completion of thoracic endovascular aortic repair after proximal ascending-arch graft replacement.
METHODS
This was a multicentre, observational study. Data were collected prospectively between January 2002 and March 2019 and analysed retrospectively. Inclusion criteria for the final analysis were the treatment of elective or urgent ETAA performed in a single-stage or a planned two-stage approach. Early and late survival rates were the primary outcomes.
RESULTS
Indications for repair were degenerative ETAA in 27 (64.3%) patients and dissection-related ETAA in 15 (35.7%). The mean aortic diameter was 68 ± 16 mm (interquartile range 60–75). Five (11.9%) patients had a single-stage repair; and 37 underwent a two-stage approach. Three (7.1%) patients died in-hospital. The median follow-up was 49 months (range 0–204). During the follow-up period, 4 (9.5%) patients underwent aortic reintervention after a median of 32 months; however, no aortic rupture of the treated segment occurred. Overall, the estimated survival rate was 85% ± 6% [95% confidence interval (CI) 70.8–93] at 12 and 36 months and 69.5% ± 9% (95% CI 49.7–84) at 60 months.
CONCLUSIONS
Hybrid repair of ETAA had satisfactory early results in this cohort of patients. At the midterm follow-up, the aneurysm-related mortality rate was acceptable with the reconstruction proving to be durable and safe with few distal aortic events.
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Affiliation(s)
- Gabriele Piffaretti
- Vascular Surgery, Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Santi Trimarchi
- Vascular Surgery, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Guido Gelpi
- Cardiac Surgery, ASST Fatebenefratelli Sacco University Teaching Hospital, Milano, Italy
| | - Claudia Romagnoni
- Cardiac Surgery, ASST Fatebenefratelli Sacco University Teaching Hospital, Milano, Italy
| | - Sandro Ferrarese
- Vascular Surgery, Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
- Cardiac Surgery, Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Matteo Tozzi
- Vascular Surgery, Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Ruth L Bush
- University of Houston College of Medicine, Houston, TX, USA
| | - Chiara Lomazzi
- Vascular Surgery, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Lomazzi C, Trimarchi S, Pyeritz RE, Bekeredjian R, Erlich MP, Braverman AC, Pacini D, Shermerhorn M, Myrmel T, Eagle KA. Lesson learned from the International Registry of Acute Aortic Dissection (IRAD). Ital J Vasc Endovasc Surg 2020. [DOI: 10.23736/s1824-4777.20.01452-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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31
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Mascoli C, Lomazzi C, Cao P, Weaver F, Milner R, Fillinger M, Verhoeven E, Trimarchi S, Gargiulo M. Impact of Gender on Intra and Perioperative EVAR Outcome: Data Analysis from Gore Great Registry. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.530] [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: 10/25/2022]
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32
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Piffaretti G, Grassi V, Lomazzi C, Brinkman WT, Navarro TP, Jenkins MP, Trimarchi S, Bernardes RC, Procopio RJ, Schneider JE, AbuRahma AF, Kaufman JA, Pearce BJ. Thoracic endovascular stent graft repair for ascending aortic diseases. J Vasc Surg 2019; 70:1384-1389.e1. [DOI: 10.1016/j.jvs.2019.01.075] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/11/2019] [Indexed: 12/29/2022]
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33
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Lomazzi C, Grassi V, Domanin M, De Vincentiis C, Piffaretti G, Trimarchi S. Art of operative techniques: treatment options in arch penetrating aortic ulcer. Ann Cardiothorac Surg 2019; 8:500-508. [PMID: 31463216 DOI: 10.21037/acs.2019.07.06] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/16/2023]
Abstract
Penetrating aortic ulcer (PAU) of the arch has a focal extent which often represents an adequate anatomic target for thoracic endovascular aortic repair (TEVAR). However, the anatomic constraints represented by the supra-aortic vessels pose either clinical or technical challenges that increase when the PAU develops proximally in the arch. Currently, different types of endografts are commercially available and have been used to treat aortic arch lesions. These include branched/fenestrated endografts for a total endovascular approach, and standard devices that can be used in combination with open/hybrid surgical operations, with the aim to exploit the minimally invasive nature of TEVAR by extending the proximal landing zone when necessary. We describe several current techniques adopted in such settings.
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Affiliation(s)
- Chiara Lomazzi
- Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Viviana Grassi
- Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Domanin
- Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Carlo De Vincentiis
- Cardiac Surgery Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Santi Trimarchi
- Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
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Lomazzi C, Grassi V, Segreti S, Cova M, Bissacco D, Bush RL, Trimarchi S. Corrigendum to 'Pre-operative Color Doppler Ultrasonography Predicts Endovenous Heat Induced Thrombosis After Endovenous Radiofrequency Ablation' [European Journal of Vascular & Endovascular Surgery 56/1 (2018) 94-100]. Eur J Vasc Endovasc Surg 2018; 56:921. [PMID: 30292580 DOI: 10.1016/j.ejvs.2018.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Chiara Lomazzi
- Vascular Surgery II and Thoracic Aortic Research Centre, IRCCS Policlinico San Donato Teaching Hospital, University of Milan School of Medicine, Milan, Italy.
| | - Viviana Grassi
- Vascular Surgery II and Thoracic Aortic Research Centre, IRCCS Policlinico San Donato Teaching Hospital, University of Milan School of Medicine, Milan, Italy
| | - Sara Segreti
- Vascular Surgery II and Thoracic Aortic Research Centre, IRCCS Policlinico San Donato Teaching Hospital, University of Milan School of Medicine, Milan, Italy
| | - Marta Cova
- Vascular Surgery II and Thoracic Aortic Research Centre, IRCCS Policlinico San Donato Teaching Hospital, University of Milan School of Medicine, Milan, Italy
| | - Daniele Bissacco
- Vascular Surgery II and Thoracic Aortic Research Centre, IRCCS Policlinico San Donato Teaching Hospital, University of Milan School of Medicine, Milan, Italy
| | - Ruth L Bush
- Baylor College of Medicine and the Centre for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA
| | - Santi Trimarchi
- Vascular Surgery II and Thoracic Aortic Research Centre, IRCCS Policlinico San Donato Teaching Hospital, University of Milan School of Medicine, Milan, Italy
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35
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Lomazzi C, Grassi V, Segreti S, Cova M, Bissacco D, Bush RL, Trimarchi S. Pre-operative Color Doppler Ultrasonography Predicts Endovenous Heat Induced Thrombosis after Endovenous Radiofrequency Ablation. Eur J Vasc Endovasc Surg 2018; 56:94-100. [DOI: 10.1016/j.ejvs.2018.02.025] [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] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 02/19/2018] [Indexed: 10/16/2022]
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36
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Piffaretti G, Lomazzi C, Benedetto F, Pipitò N, Castelli P, Trimarchi S, Dorigo W, Tozzi M. Best Medical Treatment and Selective Stent-GraftRepair for Acute Type B Aortic Intramural Hematoma. Semin Thorac Cardiovasc Surg 2018; 30:279-287. [DOI: 10.1053/j.semtcvs.2018.02.006] [Citation(s) in RCA: 6] [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] [Accepted: 02/02/2018] [Indexed: 12/15/2022]
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37
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Piffaretti G, Ottavi P, Lomazzi C, Franchin M, Micheli R, Ferilli F, Dorigo W, Marrocco-Trischitta M, Castelli P, Trimarchi S. Thoracic Endovascular Aortic Repair for Type B Acute Aortic Dissection Complicated by Descending Thoracic Aneurysm. Eur J Vasc Endovasc Surg 2017; 53:793-801. [DOI: 10.1016/j.ejvs.2017.02.022] [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] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/21/2017] [Indexed: 01/03/2023]
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38
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Piffaretti G, Galli M, Lomazzi C, Franchin M, Castelli P, Mariscalco G, Trimarchi S. Endograft repair for pseudoaneurysms and penetrating ulcers of the ascending aorta. J Thorac Cardiovasc Surg 2016; 151:1606-14. [DOI: 10.1016/j.jtcvs.2015.12.055] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 12/18/2015] [Accepted: 12/24/2015] [Indexed: 11/30/2022]
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Trimarchi S, Kamman A, Lomazzi C, Segreti S, Cova M, De Vincentiis C, Frigiola A, Menicanti L, Marrocco-Trischitta MM, Grassi V, Morganti S, Conti M, Auricchio F, Rampoldi V. Activities at Thoracic Aortic Research Center, IRCCS Policlinico San Donato. Eur Heart J Suppl 2016; 18:E57-E63. [PMID: 28533718 DOI: 10.1093/eurheartj/suw015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The Thoracic Aortic Research Center (TARC) of the IRCCS Policlinico San Donato (PSD) aims to promote research on thoracic aortic diseases, to disclose the scientific knowledge and clinical experience and to develop new scientific paths within the Hospital and the aortic community, in collaboration with other national and international centres. Thoracic Aortic Research Center collaborates with many centres in both Europe (e.g. University of Utrecht, the Netherlands) and the USA (e.g. University of Michigan). This has led to multiple highly regarded publications in respected cardiovascular journals and has led to several PhD programmes resulting in doctorate degrees. Within Italy, in association with the Bioengineering School of the University of Pavia, TARC has founded the "BETA-lab" (Biomechanics for Endovascular Treatment of the Aorta laboratory), where MDs, Bioengineers, and PhD fellows conduct experimental studies using in vitro/ex vivo models of the physiologic aorta and aortic diseases. Furthermore, a database (iCardiocloud) where the medical imaging of cardiovascular patients from the PSD is structured, for in silico analysis utilizing computational fluid dynamics, and in vitro studies using also 3D printed aortic models. With the role of principal investigator or co-investigator, TARC at PSD has been participating in other several projects, including the International Registry of Acute Aortic Dissection, the International Aortic Arch Surgery Study Group, the European Registry of Endovascular Aortic Repair Complications, the ADSORB and ASSIST trials, and the GREAT registry. International collaborations have included also studies on predictors of aortic growth after dissection with the Yale University and University of Virginia, and on aortic biomarkers with the University of Tokyo.
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Affiliation(s)
- Santi Trimarchi
- Section of Vascular Surgery II°, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Arnoud Kamman
- Section of Vascular Surgery II°, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Chiara Lomazzi
- Section of Vascular Surgery II°, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Sara Segreti
- Section of Vascular Surgery II°, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Marta Cova
- Section of Vascular Surgery II°, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Carlo De Vincentiis
- Section of Cardiac Surgery, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, San Donato Milanese, Milan, Italy
| | - Alessandro Frigiola
- Section of Cardiac Surgery, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, San Donato Milanese, Milan, Italy
| | - Lorenzo Menicanti
- Section of Cardiac Surgery, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, San Donato Milanese, Milan, Italy
| | - Massimiliano M Marrocco-Trischitta
- Section of Vascular Surgery II°, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Viviana Grassi
- Section of Vascular Surgery II°, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Simone Morganti
- Department of Civil Engineering and Architecture, University of Pavia, Italy
| | - Michele Conti
- Department of Civil Engineering and Architecture, University of Pavia, Italy
| | | | - Vincenzo Rampoldi
- Section of Vascular Surgery II°, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
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Lomazzi C, Grassi V, Segreti S, Bissacco D, Cova M, Trimarchi S. Preoperative Ultrasound Analysis Can Predict Endovenous Heat-Induced Thrombosis in Patient Candidates for Endovenous Treatment of Superficial Vein Insufficiency. J Vasc Surg Venous Lymphat Disord 2016. [DOI: 10.1016/j.jvsv.2015.10.032] [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: 10/22/2022]
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Trimarchi S, Segreti S, Grassi V, Lomazzi C, Cova M, Piffaretti G, Rampoldi V. Open fenestration for complicated acute aortic B dissection. Ann Cardiothorac Surg 2014; 3:418-22. [PMID: 25133107 DOI: 10.3978/j.issn.2225-319x.2014.07.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 07/28/2014] [Indexed: 01/28/2023]
Abstract
Acute type B aortic dissection (ABAD) is a serious cardiovascular emergency in which morbidity and mortality are often related to the presence of complications at clinical presentation. Visceral, renal, and limb ischemia occur in up to 30% of patients with ABAD and are associated with higher in-hospital mortality. The aim of the open fenestration is to resolve the malperfusion by creating a single aortic lumen at the suprarenal or infrarenal level. This surgical procedure is less invasive than total aortic replacement, thus not requiring extracorporeal support and allowing preservation of the intercostal arteries, which results in decreased risk of paraplegia. Surgical aortic fenestration represents an effective and durable option for treating ischemic complications of ABAD, particularly for patients with no aortic dilatation. In the current endovascular era, this open technique serves as an alternative option in case of contraindications or failure of endovascular management of complicated ABAD.
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Affiliation(s)
- Santi Trimarchi
- 1 Thoracic Aortic Research Center, Cardiovascular Surgery, Policlinico San Donato IRCCS, Milan, Italy ; 2 Section of Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Sara Segreti
- 1 Thoracic Aortic Research Center, Cardiovascular Surgery, Policlinico San Donato IRCCS, Milan, Italy ; 2 Section of Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Viviana Grassi
- 1 Thoracic Aortic Research Center, Cardiovascular Surgery, Policlinico San Donato IRCCS, Milan, Italy ; 2 Section of Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Chiara Lomazzi
- 1 Thoracic Aortic Research Center, Cardiovascular Surgery, Policlinico San Donato IRCCS, Milan, Italy ; 2 Section of Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Marta Cova
- 1 Thoracic Aortic Research Center, Cardiovascular Surgery, Policlinico San Donato IRCCS, Milan, Italy ; 2 Section of Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Gabriele Piffaretti
- 1 Thoracic Aortic Research Center, Cardiovascular Surgery, Policlinico San Donato IRCCS, Milan, Italy ; 2 Section of Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Vincenzo Rampoldi
- 1 Thoracic Aortic Research Center, Cardiovascular Surgery, Policlinico San Donato IRCCS, Milan, Italy ; 2 Section of Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Hospital, University of Insubria School of Medicine, Varese, Italy
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Trimarchi S, Segreti S, Grassi V, Lomazzi C, de Vincentiis C, Rampoldi V. Emergent treatment of aortic rupture in acute type B dissection. Ann Cardiothorac Surg 2014; 3:319-24. [PMID: 24967173 DOI: 10.3978/j.issn.2225-319x.2014.05.05] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 05/16/2014] [Indexed: 11/14/2022]
Abstract
Massive left hemothorax is a rare and dramatic complication of acute type B aortic dissection. The primary endpoint is to treat the aortic rupture, stop the bleeding and stabilize the hemodynamic status, with the aim to prevent mortality and major cardiac, cerebral, visceral and renal complications. Thoracic endovascular repair (TEVAR) is the most frequent management, although its planning, in these emergent patients, may be very difficult and sub-optimal imaging may result at post-operative examination (CT and MRI). In case of TEVAR is not the definitive treatment of the aortic disease, a second stage surgical management can be performed in elective status, in a patient with a total clinical recover. In acute and dramatic circumstances, like ruptured type B dissection, TEVAR is a valid and suitable bridge procedure to open surgery, reducing the overall risk for mortality and major complications.
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Affiliation(s)
- Santi Trimarchi
- Thoracic Aortic Research Center, Cardiovascular Surgery, Policlinico San Donato IRCCS, Milan, Italy
| | - Sara Segreti
- Thoracic Aortic Research Center, Cardiovascular Surgery, Policlinico San Donato IRCCS, Milan, Italy
| | - Viviana Grassi
- Thoracic Aortic Research Center, Cardiovascular Surgery, Policlinico San Donato IRCCS, Milan, Italy
| | - Chiara Lomazzi
- Thoracic Aortic Research Center, Cardiovascular Surgery, Policlinico San Donato IRCCS, Milan, Italy
| | - Carlo de Vincentiis
- Thoracic Aortic Research Center, Cardiovascular Surgery, Policlinico San Donato IRCCS, Milan, Italy
| | - Vincenzo Rampoldi
- Thoracic Aortic Research Center, Cardiovascular Surgery, Policlinico San Donato IRCCS, Milan, Italy
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Abstract
Although major improvement has occurred to make elective repair of abdominal aortic aneurysms a safe procedure, the incidence of ruptured abdominal aortic aneurysms and mortality rates are still disappointing. Endovascular abdominal aortic aneurysm repair has produced quantum changes in aneurysm treatment. The successful application of the endovascular approach for the treatment of abdominal aortic aneurysms in the elective setting has prompted a strong interest regarding its possible use in dealing with the long-standing challenge of a ruptured abdominal aortic aneurysm. Since the first report, several centers have reported results and a wide spectrum of opinion regarding its application, with special consideration to logistical and practical barriers for appropriate utilization. The purpose of this article is to review all the available literature on the endovascular repair of ruptured abdominal aortic aneurysms and to analyze the most recent trends in their management, with special consideration given to comparing results of conventional and endovascular approaches.
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Affiliation(s)
- Gabriele Piffaretti
- University of Insubria, Vascular Surgery-Department of Surgery, Viale Borri 57 21100, Varese, Italy.
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Carnini M, Piffaretti G, Lomazzi C. Stent–graft repair of carotid endarterectomy–related pseudoaneurysm. Journal of Acute Disease 2013. [DOI: 10.1016/s2221-6189(13)60098-0] [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: 10/26/2022] Open
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Piffaretti G, Lomazzi C, Carrafiello G, Tozzi M, Mariscalco G, Castelli P. Visceral artery aneurysms: management of 48 cases. J Cardiovasc Surg (Torino) 2011; 52:557-565. [PMID: 21792163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM The purpose of this study was to review the outcomes of endovascular treatment and open repair of visceral artery aneurysms, and to compare their results. METHODS Between January 1995 and January 2009, 42 patients (22 males) underwent surgical or endovascular treatment for visceral artery aneurysms. Mean age was 60 ± 13 (range, 35-85). Overall, 12 patients (25%) were asymptomatic, twenty-six patients (54.2%) were symptomatic, and 10 aneurysms (20.8%) were ruptured. The first 12 cases (28.6%) were treated with open repair; thereafter, endovascular techniques were used to treat 30 VAAs (71.4%). RESULTS Ten patients were treated in emergency setting [8 in the endovascular group (26.6%) and 2 in the open repair group (16.7%), P=0.491]. In the endovascular group, primary technical success was achieved in 29 of 30 VAAs (96.6%). Overall in-hospital mortality was 2.4%. Major complications occurred in 8 patients (3 endovascular vs 5 open repair, P=0.01). Overall, mean hospitalization was 9.7 vs. 13 days (P<0.0001). Mean follow-up was 64 months (range, 3 months-14 years). In the endovascular group, reperfusion was higher in larger (>5 cm) aneurysms (P<0.0001). CONCLUSION Endovascular techniques could be the first treatment option for all visceral artery aneurysms.
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Affiliation(s)
- G Piffaretti
- Unit of Vascular Surgery, Department of Surgical Sciences, Varese University Hospital-University of Insubria Varese, Italy.
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Trimarchi S, Righini P, Grassi V, Lomazzi C, Segreti S, Rampoldi V, Verhoeven E. Do branched and fenestrated devices have a role in chronic type B aortic dissection? J Cardiovasc Surg (Torino) 2011; 52:529-538. [PMID: 21792160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Morbidity and mortality after conventional open repair of post-dissecting thoracoabdominal aortic aneurysms (TAAA) remain high despite the improvement of results. Recently, "hybrid" open de-branching procedures combined with endovascular stent-grafting of the atherosclerotic thoracic aortic aneurisms have been performed, as an alternative approach. However, patients with significant cardiac, pulmonary or renal comorbidities, may represent an unfit cohort also for such hybrid procedures, and, of consequence, may be resigned to medical treatment. Recent experiences with fenestrated and branched stent-grafts have opened new opportunities in the treatment of extensive aortic aneurysms involving the visceral and renal arteries, particularly in case of atherosclerotic aneurysms. Post-dissection thoracoabdominal aneurysms present with additional challenges such as narrow true lumen at the level of the visceral vessels origin, and the lack of a stable distal landing zone. In this report, we discuss the role of fenestrated and branched stent-grafts as feasible treatment of post-dissecting TAAA.
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Affiliation(s)
- S Trimarchi
- Research Center for Thoracic Aortic Diseases, Policlinico San Donato IRCCS, University of Milan, Milan, Italy.
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Lomazzi C, Mariscalco G, Piffaretti G, Bacuzzi A, Tozzi M, Carrafiello G, Castelli P. Endovascular treatment of elective abdominal aortic aneurysms: independent predictors of early and late mortality. Ann Vasc Surg 2010; 25:299-305. [PMID: 20926237 DOI: 10.1016/j.avsg.2010.08.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 04/08/2010] [Accepted: 08/08/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND The purpose of this study was to review our personal experience with patients who underwent elective endovascular repair of abdominal aortic aneurysms so as to detect the predictors of early and late mortality. METHODS Between November 2000 and June 2008, a total of 235 consecutive patients (218 men; mean age: 71.9 ± 8.0 years, range: 48-95 years) underwent endovascular repair of abdominal aortic aneurysms. Comorbidities were defined by using the Society for Vascular score grading system and the preoperative risk grade on the basis of the classification of the American Society of Anesthesiologists (ASA). Physical examination and spiral computed tomography were planned at 1, 4, and 12 months after the procedure, and on a yearly basis thereafter. Contrast-enhanced ultrasonography and plain X-rays were also performed. RESULTS Primary technical success rate was 97% (228 of 235 cases). The overall hospital mortality was 2.1% (n = 5), ranging from 1.2% and 2.8% for patients with an ASA of score 2 and 3, respectively, to 7.7% for patients with an ASA score of 4. Multivariable analysis confirmed chronic renal failure (OR: 12.12, 95% CI: 1.83-80.17, p = 0.010) and transrenal endograft (OR: 9.61, 95% CI: 1.01-91.57, p = 0.049) as the only independent predictors of early mortality. Follow-up was completed for all 230 patients who were discharged, with a mean follow-up period of 26.3 ± 22.7 months (maximum: 92 months). Kaplan-Meier analysis revealed a reduced survival rate for older patients (p < 0.001) and patients with a larger aneurysm (p < 0.001). A reduced survival rate was also demonstrated for women and patients with higher ASA scores (p = 0.007, and p = 0.003, respectively). In multivariate Cox analysis, ASA score, age, diameter of the aneurysm, and being female independently affected long-term survival. CONCLUSION On the basis of our experience, it was concluded that chronic renal failure and the endograft configuration were independent predictors of early mortality. Also, older patients, women, and patients with larger aneurysms and higher ASA scores had the poorest late survival rates.
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Affiliation(s)
- Chiara Lomazzi
- Division of Vascular Surgery, Department of Surgical Sciences, Varese University Hospital, University of Insubria, Via Guicciardini 9, Varese, Italy
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Piffaretti G, Mariscalco G, Lomazzi C, Rivolta N, Riva F, Tozzi M, Carrafiello G, Bacuzzi A, Mangini M, Banach M, Castelli P. Predictive factors for endoleaks after thoracic aortic aneurysm endograft repair. J Thorac Cardiovasc Surg 2009; 138:880-5. [PMID: 19660353 DOI: 10.1016/j.jtcvs.2009.02.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [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] [Received: 07/10/2008] [Revised: 12/05/2008] [Accepted: 02/03/2009] [Indexed: 11/15/2022]
Abstract
BACKGROUND Our prospective investigation aimed to determine and analyze the incidence and the determinants of endoleaks after thoracic stent graft. METHODS Sixty-one patients affected by thoracic aortic aneurysms were treated between January 2000 and March 2008. The study cohort contained 54 men, with a mean age of 63.6 +/- 17.9 years. The follow-up imaging protocol included chest radiographs and triple-phase computed tomographic angiography performed at 1, 4, and 12 postoperative months and annually thereafter. RESULTS Median follow-up was 32.4 months (range: 1-96 months). Endoleaks were detected in 9 (14.7%) patients, of which 7 were type 1. Five endoleaks were detected at 30 postoperative days, and the other 4 developed with a mean delay of 12 months. Endovascular or hybrid interventions were used to treat the endoleaks. Secondary technical success rate was 100%. Multivariate analysis demonstrated that the diameter of the aneurysmal aorta (odds ratio 1.75, 95% confidence interval 1.07-2.86) and the coverage of the left subclavian artery (odds ratio 12.05, 95% confidence interval 1.28-113.30) were independently associated with endoleak development. The percentages of patients in whom reinterventions were unnecessary were 94.6% +/- 3.0%, 88.3% +/- 4.5%, and 85.4% +/- 5.2%, at 1, 2, and 5 years, respectively. The actuarial survival estimates at 1, 2, and 5 years were 85.2% +/- 4.6%, 78.1% +/- 5.4%, and 70.6% +/- 6.4%, respectively. CONCLUSIONS The diameter of the aneurysmal aorta and the position of the landing zone are independent predictors of endoleak occurrence after thoracic stent-graft procedures. A careful follow-up program should be considered in patients in whom these indices are unfavorable, because most of the endoleaks may be successfully and promptly treated by additional endovascular procedures.
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Affiliation(s)
- Gabriele Piffaretti
- Department of Surgical Sciences, Vascular Surgery Unit, Varese University Hospital, Varese, Italy
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Lomazzi C, Carcano G, Piffaretti G, Tozzi M, Castelli P. Endovascular repair of abdominal aortic aneurysms in octogenarians. BMC Geriatr 2009. [PMCID: PMC4291020 DOI: 10.1186/1471-2318-9-s1-a71] [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: 12/03/2022] Open
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Piffaretti G, Tozzi M, Mariscalco G, Bacuzzi A, Lomazzi C, Rivolta N, Carrafiello G, Castelli P. Mobile Thrombus of the Thoracic Aorta: Management and Treatment Review. Vasc Endovascular Surg 2008; 42:405-11. [DOI: 10.1177/1538574408324737] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Detection of mobile thrombus of the thoracic aorta has become increasingly higher after any embolic event. Although the indication for treatment remains controversial, there is a growing interest about the ethiopathogenesis of this rare entity, and to define proper diagnostic and therapeutic approaches. The purpose of this article was to review the current management strategies and follow-up results of this rare pathology.
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Affiliation(s)
- Gabriele Piffaretti
- Vascular Surgery, Department of Surgical Sciences, University of Insubria, Varese, Italy, gabriele.piffaretti@ tiscali.it
| | - Matteo Tozzi
- Vascular Surgery, Department of Surgical Sciences, University of Insubria, Varese, Italy
| | - Giovanni Mariscalco
- Cardiac Surgery, Department of Surgical Sciences, University of Insubria, Varese, Italy
| | - Alessandro Bacuzzi
- Anaesthesia and Palliative Care, Circolo University Hospital, Varese, Italy
| | - Chiara Lomazzi
- Vascular Surgery, Department of Surgical Sciences, University of Insubria, Varese, Italy
| | - Nicola Rivolta
- Vascular Surgery, Department of Surgical Sciences, University of Insubria, Varese, Italy
| | - Gianpaolo Carrafiello
- Interventional Radiology, Department of Radiology, University of Insubria, Varese, Italy
| | - Patrizio Castelli
- Vascular Surgery, Department of Surgical Sciences, University of Insubria, Varese, Italy
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