1
|
Spinella G, Pisa FR, Boschetti GA, Finotello A, Pane B, Pratesi G, Lanzarone E. Reconsidering the Impact of Endovascular Repair on Short-Term and Mid-Term Outcomes in Peripheral Arterial Disease: A Retrospective Analysis. Ann Vasc Surg 2024; 103:141-150. [PMID: 38395344 DOI: 10.1016/j.avsg.2023.12.068] [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: 09/18/2023] [Revised: 11/25/2023] [Accepted: 12/10/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND The aim of the study is to compare the short-term and medium-term outcomes in patients who underwent open repair (OR) or endovascular repair (ER) for peripheral arterial disease (PAD) also including stratifications based on severity and year of the first intervention. METHODS We conducted an observational retrospective single-center cohort study. We evaluated patients with PAD that primarily underwent ER, OR, minor, and major amputations in a single center from 2005 to 2020. The patients were then subdivided according to the type of intervention (OR versus ER), and stratified according to the International Classification of Diseases 9 code reported in the operating documents and to the year intervention. Mortality, minor, and major amputation rates occurring at 30 days, 2 years, and 5 years after the first intervention were evaluated as primary outcomes and compared between patient groups in both stratifications. Moreover, Kaplan-Maier curves were analyzed for these outcomes. RESULTS One thousand four hundred ninety two patients (67.0% males) with PAD were evaluated. Their clinical presentations were intermittent claudication in 51.4% of cases, rest pain in 16.8%, ulcers in 10.3%, and gangrene in 21.5%. Nine hundred ninety seven (66.8%) underwent OR and 495 (33.2%) ER as first intervention for PAD. No statistical differences were observed in terms of mortality in the 2 groups (OR versus ER, P = 1,000, P = 0.357, and P = 0.688 at 30 days, 2 years, and 5 years, respectively). The rate of minor amputations was significantly higher (P < 0.012, P < 0.002, and P < 0.007 at 30 days, 2 years, and 5 years, respectively) for ER group in any of the observed follow-up periods. Also, we have observed that OR and ER do not have any significant short-term and medium-term major amputation rate differences. CONCLUSIONS In our experience, the impact of ER does not significantly change short-term and mid-term major outcomes in patients with PAD.
Collapse
Affiliation(s)
- Giovanni Spinella
- Department of Surgical and Integrated Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Vascular and Endovascular Surgery Clinic, Genoa, Italy.
| | - Fabio Riccardo Pisa
- Department of Surgical and Integrated Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
| | - Gian Antonio Boschetti
- Vascular Surgery Unit, AULSS 2 Marca Trevigiana, Treviso Regional Hospital, Treviso, Italy
| | | | - Bianca Pane
- Department of Surgical and Integrated Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Vascular and Endovascular Surgery Clinic, Genoa, Italy
| | - Giovanni Pratesi
- Department of Surgical and Integrated Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Vascular and Endovascular Surgery Clinic, Genoa, Italy
| | - Ettore Lanzarone
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| |
Collapse
|
2
|
Spinella G, Fantazzini A, Finotello A, Vincenzi E, Boschetti GA, Brutti F, Magliocco M, Pane B, Basso C, Conti M. Artificial Intelligence Application to Screen Abdominal Aortic Aneurysm Using Computed tomography Angiography. J Digit Imaging 2023; 36:2125-2137. [PMID: 37407843 PMCID: PMC10501994 DOI: 10.1007/s10278-023-00866-1] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/13/2023] [Accepted: 06/06/2023] [Indexed: 07/07/2023] Open
Abstract
The aim of our study is to validate a totally automated deep learning (DL)-based segmentation pipeline to screen abdominal aortic aneurysms (AAA) in computed tomography angiography (CTA) scans. We retrospectively evaluated 73 thoraco-abdominal CTAs (48 AAA and 25 control CTA) by means of a DL-based segmentation pipeline built on a 2.5D convolutional neural network (CNN) architecture to segment lumen and thrombus of the aorta. The maximum aortic diameter of the abdominal tract was compared using a threshold value (30 mm). Blinded manual measurements from a radiologist were done in order to create a true comparison. The screening pipeline was tested on 48 patients with aneurysm and 25 without aneurysm. The average diameter manually measured was 51.1 ± 14.4 mm for patients with aneurysms and 21.7 ± 3.6 mm for patients without aneurysms. The pipeline correctly classified 47 AAA out of 48 and 24 control patients out of 25 with 97% accuracy, 98% sensitivity, and 96% specificity. The automated pipeline of aneurysm measurements in the abdominal tract reported a median error with regard to the maximum abdominal diameter measurement of 1.3 mm. Our approach allowed for the maximum diameter of 51.2 ± 14.3 mm in patients with aneurysm and 22.0 ± 4.0 mm in patients without an aneurysm. The DL-based screening for AAA is a feasible and accurate method, calling for further validation using a larger pool of diagnostic images towards its clinical use.
Collapse
Affiliation(s)
- Giovanni Spinella
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV 6, 16132, Genoa, Italy.
- Vascular and Endovascular Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy.
| | | | | | - Elena Vincenzi
- Camelot Biomedical System, Genoa, Italy
- Department of Computer Science, Robotics and Systems Engineering, University of Genoa, BioengineeringGenoa, Italy
| | | | | | - Marco Magliocco
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Bianca Pane
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV 6, 16132, Genoa, Italy
- Vascular and Endovascular Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy
| | | | - Michele Conti
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| |
Collapse
|
3
|
Spinella G, Boschetti GA, Bauckneht M, Raffa S, Marini C, Finotello A, Pane B, Pratesi G, Palombo D, Sambuceti G. Endovascular aortic repair impact on myocardial contractility: A prospective study. Eur J Clin Invest 2023; 53:e14011. [PMID: 37099603 DOI: 10.1111/eci.14011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/07/2023] [Accepted: 04/24/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND This study aimed to estimate if the altered sphygmic wave transmission may affect the left ventricular (LV) contractile function in patients undergoing endovascular aortic repair (EVAR). METHODS A prospective single-centre study was carried out on consecutive patients undergoing EVAR for abdominal aortic aneurysm. A preoperative and 6-month single photon emission computed tomography (SPECT) with arterial stiffness measurement were performed to evaluate variations in pressure wave curve and myocardial perfusion parameters. RESULTS From 2018 to 2020 a total of 16 patients were included in the study. Among the parameters evaluated, we found a measurable reduction of the reflected wave transit time from pre- to postoperative period, for both stress (115.13 ± 7.2 ms-111.1 ± 7.0 ms, p = .08) and rest SPECT acquisitions (115.3 ± 6.2 ms-112.2 ± 5.6 ms, p = .1). Unidirectional increase of both LV end-systolic volume (34 ± 9 mL-39 ± 8 mL, p = .02) and end-diastolic volume (85 ± 34 mL-89 ± 29 mL, p = .6) was also observed. Lastly, the ratio between the end-systolic pressure and the end-systolic volume (maximal systolic myocardial stiffness) decreased from 3.6 ± 1.5 mmHg/mL to 2.66 ± .74 mmHg/mL (p = .03). CONCLUSIONS Our data showed that EVAR induced an altered transmission of the sphygmic wave associated with an early LV contractile impairment.
Collapse
Affiliation(s)
- Giovanni Spinella
- Vascular and Endovascular Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Gian Antonio Boschetti
- Vascular and Endovascular Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Matteo Bauckneht
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Stefano Raffa
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Cecilia Marini
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- CNR Institute of Molecular Bioimaging and Physiology (IBFM), Segrate, Italy
| | - Alice Finotello
- Vascular and Endovascular Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Bianca Pane
- Vascular and Endovascular Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Giovanni Pratesi
- Vascular and Endovascular Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Domenico Palombo
- Vascular and Endovascular Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Gianmario Sambuceti
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| |
Collapse
|
4
|
Finotello A, Schuurmann R, Di Gregorio S, Boschetti GA, Chakfé N, Pane B, Spinella G, de Vries JP, Palombo D, Pratesi G. Initial Clinical Experience With a New Conformable Abdominal Aortic Endograft: Aortic Neck Coverage and Curvature Analysis in Challenging Aortic Necks. J Endovasc Ther 2021; 28:407-414. [PMID: 33660576 DOI: 10.1177/1526602821996723] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Aim of this work was to investigate precision of deployment and conformability of a new generation GORE EXCLUDER Conformable Endoprosthesis with active control system (CEXC Device, W.L. Gore and Associates, Flagstaff, AZ, USA) by analyzing aortic neck coverage and curvature. METHODS All consecutive elective patients affected by abdominal aortic aneurysm or aortoiliac aneurysm treated at our institution between November 2018 and June 2019 with the new CEXC Device were enrolled. Validated software was adopted to determine the available apposition surface area into the aortic neck, apposition of the endograft to the aortic wall, shortest apposition length (SAL), shortest distance between the endograft fabric and the lowest renal arteries (SFD) and between the endograft fabric and the contralateral renal artery (CFD). Pointwise centerline curvature was also computed. RESULTS Twelve patients (10 men, median age 78 years (71.75, 81.0)) with available pre- and postoperative computed tomography angiography (CTA) were included. Technical success was obtained in all the cases. Preoperative median length of the proximal aortic neck was 16.1 mm (10.7, 21.7) and suprarenal (α) and infrarenal (β) neck angulation were, respectively, 28.9° (15.7°, 47.5°) and 75.0° (66.9°, 81.4°). Postoperative median apposition surface coverage was 79% (69.25%, 90.75%) of the available apposition surface. SFD and CFD were 1.5 mm (0.75, 5.25) and 7 mm (4.5, 21.5), respectively. Average curvature over the infrarenal aorta decreased from 25 m-1 (21.75, 29.0) to 22.5 m-1 (18.75, 24.5) postoperatively (p=0.02). Maximum curvature did not decrease significantly from 64.5 m-1 (54.25, 92.0) to 62 m-1 (41.75, 71.5) (p=0.1). CONCLUSIONS Our early experience showed that deployment of the CEXC Device is safe and effective for patients with challenging proximal aortic necks. Absence of significant changes between pre- and postoperative proximal aortic neck angulations and curvature confirms the high conformability of this endograft.
Collapse
Affiliation(s)
- Alice Finotello
- Clinic of Vascular and Endovascular Surgery, Ospedale Policlinico San Martino, Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, Italy
| | - Richte Schuurmann
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, the Netherlands
| | - Sara Di Gregorio
- Clinic of Vascular and Endovascular Surgery, Ospedale Policlinico San Martino, Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, Italy
| | - Gian Antonio Boschetti
- Clinic of Vascular and Endovascular Surgery, Ospedale Policlinico San Martino, Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, Italy
| | - Nabil Chakfé
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, France.,GEPROVAS, Strasbourg, France
| | - Bianca Pane
- Clinic of Vascular and Endovascular Surgery, Ospedale Policlinico San Martino, Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, Italy
| | - Giovanni Spinella
- Clinic of Vascular and Endovascular Surgery, Ospedale Policlinico San Martino, Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, Italy
| | - Jean-Paul de Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, the Netherlands
| | - Domenico Palombo
- Clinic of Vascular and Endovascular Surgery, Ospedale Policlinico San Martino, Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, Italy
| | - Giovanni Pratesi
- Clinic of Vascular and Endovascular Surgery, Ospedale Policlinico San Martino, Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, Italy
| |
Collapse
|
5
|
Boschetti GA, Di Gregorio S, Mena Vera JM, Pane B, Spinella G, Palombo D, Pratesi G. COVID-19 Impact on Vascular Surgery Practice: Experience From an Italian University Regional Hub Center for Vascular Pathology. Ann Vasc Surg 2021; 74:73-79. [PMID: 33549797 PMCID: PMC7862030 DOI: 10.1016/j.avsg.2021.01.072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 01/08/2023]
Abstract
Background The aim of the study is to evaluate the impact of COVID-19 pandemic on vascular surgery practice in a regional hub center for complex vascular disease. Methods This is an observational single-center study in which we collected clinical and surgical data during (P1) and after (P2) the COVID-19 outbreak and the lockdown measures implemented in Northern Italy. We compared those data with the two-month period before the pandemic (P0). Results Compared to P0, ambulatory activities were severely reduced during P1 and limited to hospitalized patients and outpatients with urgent criteria. We performed 61 operations (18 urgent and 43 elective), with a decrease in both aortic (−17.8%), cerebrovascular (−53.3%), and peripheral artery (−42.6%) disease treatments. We also observed a greater drop in open procedures (−53.2%) than in endovascular ones (−22%). All the elective patients were treated for notdeferrable conditions and they were COVID-19 negative at the ward admission screening; despite this one of them developed COVID19 during the hospital stay. Four COVID-19 positive patients were treated in urgent setting for acute limb ischemia. Throughout P2 we gradually rescheduled elective ambulatory (+155.5%) and surgical (+18%) activities, while remaining substantially lower than during P0 (respectively −45.6% and −25.7%). Conclusions Despite COVID-19 pandemic, our experience shows that with careful patient's selection, dedicated prehospitalization protocol and proper use of personal protective equipment it is possible to guarantee continuity of care.
Collapse
Affiliation(s)
- Gian Antonio Boschetti
- Vascular and Endovascular Surgery Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy.
| | - Sara Di Gregorio
- Vascular and Endovascular Surgery Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Jorge Miguel Mena Vera
- Vascular and Endovascular Surgery Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Bianca Pane
- Vascular and Endovascular Surgery Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Giovanni Spinella
- Vascular and Endovascular Surgery Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Domenico Palombo
- Vascular and Endovascular Surgery Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Giovanni Pratesi
- Vascular and Endovascular Surgery Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| |
Collapse
|
6
|
Boschetti GA, Spinella G, Mambrini S, Pratesi G, Del Pizzo R, Mongelli F, Palombo D, Santori G, Bianca P. In-hospital Mortality Predictors in 1582 Patients Underwent Endovascular or Surgical Intervention for Peripheral Artery Disease: A Single Center Survival Analysis. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.363] [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: 11/15/2022]
|
7
|
Boschetti GA, Pratesi G, Pane B, Spinella G, Mambrini S, Di Bartolo M, Palombo D. Initial Clinical Experience With A New Conformable Abdominal Endograft: Precision of Deployment and Tortuosity Index Analysis in Challenging Aortic Neck. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.362] [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]
|