Author: "Luca, Bertoglio" / Language: english - Searchworks@Jio Institute Digital Library Search Results

108 results on '"Luca, Bertoglio"'

1. Prolonged Impella 5.0/5.5 support within different pathways of care for cardiogenic shock: the experience of a referral center

Author: Marina Pieri, Alessandro Ortalda, Savino Altizio, Luca Bertoglio, Pasquale Nardelli, Evgeny Fominskiy, Elisabetta Lapenna, Silvia Ajello, and Anna Mara Scandroglio
Subjects: mechanical circulatory support, cardiogenic shock, Impella, myocardial recovery, LVAD, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: AimsImpella 5.0 and 5.5 are promising low-invasive left ventricle (LV) temporary mechanical circulatory supports (tMCS) for cardiogenic shock due to LV mechanical unloading and are paired with powerful hemodynamic support. This study aimed to analyze data and destinies of patients supported with Impella 5.0/5.5 at a national referral center for cardiogenic shock and to assess the parameters associated with myocardial recovery and successful weaning.MethodsA single-center observational study was conducted on all patients treated with Impella 5.0 or 5.5 from March 2018 to July 2023.ResultsA total of 59 patients underwent Impella 5.0/5.5 implantation due to profound cardiogenic shock, with acute myocardial infarction being the most frequent cause of shock (42 patients, 71%). The median duration of Impella support was 13 days (maximum duration of 52 days). Axillary cannulation was feasible in almost all patients, and 36% were mobilized during support. A total of 44 patients (75%) survived to the next therapy/recovery: 21 patients experienced recovery and 15 and 8 were bridged to long-term LVAD and heart transplantation, respectively. The global survival rate was 66%. The predictors of native heart recovery at multivariate analysis were the number of days on tMCS before upgrade to Impella 5.0/5.5 [hazard ratio (HR) 0.68 (0.51–9) p = 0.0068] and improvement of LVEF within the first 7–10 days of support [HR 4.72 (1.34–16.7), p = 0.016].ConclusionsTranscatheter systems such as Impella 5.0/5.5 revolutionized the field of tMCS. Myocardial recovery is the primary clinical target. Its prognostication and promotion are key to ensure the most proficuous course for each patient from cardiogenic shock to long-term event-free survival.
Published: 2024
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2. The new educational project Televascular Games during the Coronavirus Disease 2019 pandemic

Author: Emiliano Chisci, MD, Gianbattista Parlani, MD, Emanuele Gatta, MD, Giacomo Isernia, MD, Gianmarco de Donato, MD, Michele Antonello, MD, Gioele Simonte, MD, Tilo Kölbel, MD, Luca Bertoglio, MD, Kak Khee Yeung, MD, Konstantinos Donas, MD, Stefano Fazzini, MD, Nuno Dias, MD, and Stefano Michelagnoli, MD
Subjects: Telemedicine, Telehealth, Teleconsultation, Education, Training, Thoraco-abdominal aortic disease, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Objective: To report methodology and first-year results of a new educational project called Televascular Games,” which took place during coronavirus disease 2019 pandemic. Methods: Complex aneurysmal aortic disease was discussed during a 2-hour competition webinar, according to three modalities. (1) Planning case competition (PCC): Two to four preoperative computed tomography angiography (CTA) scans of an already performed selected case were submitted for the competition. CTA scans were uploaded anonymously, without any reference to the center or the surgeon who performed the case. The competitor had to prepare a presentation of how he or she would have diagnosed, sized, planned, treated, and followed up the case, of the medical therapy and of the bail-out maneuvers. (2) Challenging case competition (CCC): The competitor elaborates a presentation of an already treated case concerning an aortic topic and discusses sizing, planning, treatment, possible bail-out maneuvers and obtained results. For the CCC and PCC, the competitors with the best score were preselected to present and discuss their plan during the webinars. (3) Quiz competition: Two to six CTA scans of already performed selected aortic cases were submitted for the competition. A quiz with multiple choice questions was answered by the competitors. The top four competitors were selected for the webinars and then they discussed the cases during the webinar. Finally, at the end of the case discussion, the effective case resolution and follow-up were shown. A final winner was voted via televoting, based on six preestablished criteria. The project was endorsed by different national and international societies. Results: Between October 2020 and December 2021, there were 12 Italian and 1 international webinars with 1695 participants overall (mean, 130; range, 86-177). Competitors were 54 years of age (mean, 27 years; range, 22-38 years). Two editions were CCCs, two quiz competitions, and nine PCCs. The reliability of the interobserver sizing of competitors was κ = 0.43 and κ = 0.62 for the proximal and distal sealing measurements respectively and very good (κ = 0.88-0.95) in the evaluation of orientation of the vessels, presence of angulations, calcifications, and thrombus. The sizing discrepancy resulted in a significant variability of the planning (κ = 0.45). The project ranked 9.6 on a 10-point rating scale by all the participants and competitors. Conclusions: The formula of gaming and collegial discussion of aortic cases herein reported has proved valid and attractive during coronavirus disease 2019 pandemic period. The variability of the results on sizing and planning suggested to confer with a second opinion, especially for less experienced surgeons.
Published: 2022
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3. Sex Influence on Fenestrated and Branched Endovascular Aortic Aneurysm Repair: Outcomes From a National Multicenter Registry.

Author: Isernia, Giacomo, Simonte, Gioele, Gallitto, Enrico, Bertoglio, Luca, Fargion, Aaron, Melissano, Germano, Chiesa, Roberto, Lenti, Massimo, Pratesi, Carlo, Faggioli, Gianluca, Gargiulo, Mauro, Luigi, Baccani, Luca, Bertoglio, Roberto, Chiesa, Gianluca, Faggioli, Aaron, Fargion, Cecilia, Fenelli, Gianluigi, Fino, Enrico, Gallitto, and Mauro, Gargiulo
Abstract: Introduction: Women are generally underrepresented in trials focusing on aortic aneurysm. Nevertheless, sex-related differences have recently emerged from several studies and registries. The aim of this research was to assess whether sex-related anatomical disparities existed in fenestrated and branched aortic repair candidates and whether these discrepancies could influence endovascular repair outcomes. Methods: Data from all consecutive patients treated during the 2008–2019 period within the Italian Multicenter fenestrated or branched endovascular aortic repair (F/BEVAR) Registry were included in the present study. Propensity matching was performed using a logistic regression model adjusted for demographic data and comorbidities to obtain comparable male and female samples. The selection model led to a final study population of 176 patients (88 women and 88 men) among the total initial cohort of 596. Study endpoints were technical and clinical success, overall survival, aneurysm-related death, and reintervention rates evaluated at 30 days and during follow-up. Results: Twenty-eight patients (15.9%) received urgent/emergent repair. In most of the cases (71.6%), women received treatment for extensive thoracoabdominal pathology (Crawford type I, II, or III aneurysm rather than type IV or juxta-pararenal) versus 46.6% of men (p=0.001). Female patients presented with more challenging iliac accesses with at least one side considered hostile in 27.3% of the cases (vs 13.6% in male patients, p=0.039). Finally, women had significantly smaller visceral vessels. Women had significantly worse operative outcomes, with an 86.2% technical success rate versus 96.6% in the male population (p=0.016). No differences were recorded in terms of 30-day reinterventions between men and women. The 5-year estimate of freedom from late reintervention, according to Kaplan-Meier analysis, was 85.6% in men versus 81.6% in women (p=ns). No aneurysm-related death was recorded during follow-up (median observational time, 23 months [interquartile range, 7–45 months]). Conclusion: Women presented a significantly higher incidence of thoracoabdominal aneurysms, smaller visceral vessels, and more complex iliofemoral accesses, resulting in a significantly lower technical success after F/BEVAR. Further studies assessing sex-related differences are needed to properly determine the impact on outcomes and stratify procedural risks. Clinical Impact: Women are generally underrepresented in trials focusing on aortic aneurysms. Aiming to assess whether sex may affect outcomes after a complex endovascular aortic repair, a propensity score selection was applied to a total population of 596 patients receiving F/BEVAR aortic repair with the Cook platform, matching each treated female patient with a corresponding male patient. Women presented more frequently a thoracoabdominal aneurysm extent, smaller visceral vessels, and complex iliofemoral accesses, resulting in significantly worse operative outcomes, with an 86.2% technical success versus 96.6% (p=0.016). No differences were recorded in terms of short-term and mid-term reinterventions. According to these results, careful and critical assessment should be posed in case of female patients receiving complex aortic repair, especially regarding preoperative anatomical evaluation and clinical selection with appropriate surgical risk stratification. [ABSTRACT FROM AUTHOR]
Published: 2024
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4. Preoperative and postoperative predictors of clinical outcome of fenestrated and branched endovascular repair for complex abdominal and thoracoabdominal aortic aneurysms in an Italian multicenter registry

Author: Luca, Bertoglio, Roberto, Chiesa, Gianluca, Faggioli, Aaron, Fargion, Cecilia, Fenelli, Enrico, Gallitto, Mauro, Gargiulo, Giacomo, Isernia, Massimo, Lenti, Antonino, Logiacco, Chiara, Mascoli, Germano, Melissano, Rodolfo, Pini, Carlo, Pratesi, Andrea, Kahlberg, Gioele, Simonte, Sara, Speziali, Gallitto, Enrico, Faggioli, Gianluca, Melissano, Germano, Fargion, Aaron, Isernia, Giacomo, Lenti, Massimo, Pratesi, Carlo, Chiesa, Roberto, and Gargiulo, Mauro
Published: 2021
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5. Symptomatic superficial femoral artery pseudoaneurysm due to late stent fracture

Author: Victor Bilman, MD, Vincenzo Ardita, MD, Alessandro Grandi, MD, Roberto Chiesa, MD, and Luca Bertoglio, MD
Subjects: Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Late formation of pseudoaneurysm related to stent fracture is rarely described in the literature. We describe a case of spontaneous 8-cm femoral superficial artery pseudoaneurysm rupture that had developed from fracture of a stent implanted 3 years previously. Surgical repair was performed with fractured stent removal and reverse saphenous vein bypass. Keywords: Stent, Fracture, Superficial artery, Pseudoaneurysm
Published: 2020
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6. Contained rupture of an aortic arch aneurysm in a patient with syphilitic aortitis. A case report

Author: Victor Bilman, Luca Bertoglio, Germano Melissano, and Roberto Chiesa
Subjects: tertiary syphilis, aortic aneurysm, aortic rupture, endovascular technique, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Abstract Syphilitic aortitis is a rare complication of tertiary syphilis, which can lead to aortic aneurysm formation, aortic valvular insufficiency, and ostial coronary stenosis. Syphilis has re-emerged worldwide over recent decades and vascular surgeons should be aware of its cardiovascular manifestations. Atypical clinical presentation, such as hemoptysis and a computed tomography angiography pattern of a thicker aneurysmal wall with ulcer-like aneurysm projections, should raise suspicion of syphilitic aortic aneurysm. An early diagnosis and appropriate surgical and medical therapies significantly contribute to successful treatment and favorable prognosis. Herein is reported the case of an 82-year-old male patient, positive for syphilis infection, with impending aortic arch aneurysm rupture treated with a hybrid arch repair. After 7 months, the patient was brought to the emergency room in cardiac arrest. Unsuccessful cardiopulmonary resuscitation maneuvers were performed, and an autopsy showed cardiac tamponade due to rupture of the ascending aorta.
Published: 2022
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7. Both Historical and Procedural Staging Reduce Spinal Cord Ischaemia Rates After Elective Fenestrated and Branched Endovascular Treatment of Extensive Thoraco-Abdominal Aortic Aneurysms in a Multicentre Registry

Author: Luca Bertoglio, Andrea Kahlberg, Enrico Gallitto, Fargion Aaron, Isernia Giacomo, Gianluca Faggioli, Germano Melissano, Maurizio Lenti, Carlo Pratesi, Mauro Gargiulo, and Roberto Chiesa
Subjects: Diseases of the circulatory (Cardiovascular) system, RC666-701, Surgery, RD1-811
Published: 2022
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8. Symptomatic internal carotid artery dissection and kinking in a patient with fibromuscular dysplasia

Author: Victor Bilman, Luca Apruzzi, Domenico Baccellieri, Francesca Sanvito, Luca Bertoglio, and Roberto Chiesa
Subjects: carotid artery, kinking, coiling, arterial dissection, fibromuscular dysplasia, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Abstract Isolated dissection of the internal carotid artery (ICA) is rare in young patients and is a cause for strong suspicion of fibromuscular dysplasia (FMD), especially when associated with artery elongation and tortuosity. The natural history of cerebrovascular FMD is unknown and management of symptomatic patients can be challenging. We report the case of a 44-year-old female patient with a history of transient ischemic attack in the absence of cardiovascular risk factors, associated with an isolated left ICA dissection and kinking. Carotid duplex ultrasound confirmed the diagnosis of dissection and demonstrated severe stenosis of the left ICA. The patient underwent surgical repair and histopathological evaluation confirmed the diagnosis of FMD with dissection. An autogenous great saphenous vein bypass was performed and the patient had an uneventful recovery. Cervical carotid artery dissection can be related to underlying arterial pathologies such as FMD, and the presence of ICA tortuosity highlights certain peculiarities for optimal management, which might be surgical.
Published: 2021
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9. Comparison of single- and multistage strategies during fenestrated-branched endovascular aortic repair of thoracoabdominal aortic aneurysms

Author: Marina Dias-Neto, Emanuel R. Tenorio, Ying Huang, Tomasz Jakimowicz, Bernardo C. Mendes, Tilo Kölbel, Jonathan Sobocinski, Luca Bertoglio, Barend Mees, Mauro Gargiulo, Nuno Dias, Andres Schanzer, Warren Gasper, Adam W. Beck, Mark A. Farber, Kevin Mani, Carlos Timaran, Darren B. Schneider, Luis Mendes Pedro, Nikolaos Tsilimparis, Stéphan Haulon, Matt Sweet, Emília Ferreira, Matthew Eagleton, Kak Khee Yeung, Manar Khashram, Andrea Vacirca, Guilherme B. Lima, Aidin Baghbani-Oskouei, Katarzyna Jama, Giuseppe Panuccio, Fiona Rohlffs, Roberto Chiesa, Geert Willem Schurink, Charlotte Lemmens, Enrico Gallitto, Gianluca Faggioli, Angelos Karelis, Ezequiel Parodi, Vivian Gomes, Anders Wanhainen, Anastasia Dean, Jesus Porras Colon, Felipe Pavarino, Ryan Gouveia e Melo, Sean Crawford, Rita Garcia, Tiago Ribeiro, Kaj Olav Kappe, Samira Elize Mariko van Knippenberg, Bich Lan Tran, Sinead Gormley, Gustavo S. Oderich, Médicaments et biomatériaux à libération contrôlée: mécanismes et optimisation - Advanced Drug Delivery Systems - U 1008 (MBLC - ADDS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), The University of Texas Health Science Center at Houston (UTHealth), Surgery, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, and APH - Digital Health
Subjects: Fenestrated-branched endovascular aortic repair, [SDV]Life Sciences [q-bio], Single stage, Multistage approach, Surgery, Spinal cord injury, Cardiology and Cardiovascular Medicine, Thoracoabdominal aortic aneurysm
Abstract: International audience; ObjectiveThe aim of this study was to compare outcomes of single or multistage approach during fenestrated-branched endovascular aortic repair (FB-EVAR) of extensive thoracoabdominal aortic aneurysms (TAAAs).MethodsWe reviewed the clinical data of consecutive patients treated by FB-EVAR for extent I to III TAAAs in 24 centers (2006-2021). All patients received a single brand manufactured patient-specific or off-the-shelf fenestrated-branched stent grafts. Staging strategies included proximal thoracic aortic repair, minimally invasive segmental artery coil embolization, temporary aneurysm sac perfusion and combinations of these techniques. Endpoints were analyzed for elective repair in patients who had a single- or multistage approach before and after propensity score adjustment for baseline differences, including the composite 30-day/in-hospital mortality and/or permanent paraplegia, major adverse event, patient survival, and freedom from aortic-related mortality.ResultsA total of 1947 patients (65% male; mean age, 71 ± 8 years) underwent FB-EVAR of 155 extent I (10%), 729 extent II (46%), and 713 extent III TAAAs (44%). A single-stage approach was used in 939 patients (48%) and a multistage approach in 1008 patients (52%). A multistage approach was more frequently used in patients undergoing elective compared with non-elective repair (55% vs 35%; P < .001). Staging strategies were proximal thoracic aortic repair in 743 patients (74%), temporary aneurysm sac perfusion in 128 (13%), minimally invasive segmental artery coil embolization in 10 (1%), and combinations in 127 (12%). Among patients undergoing elective repair (n = 1597), the composite endpoint of 30-day/in-hospital mortality and/or permanent paraplegia rate occurred in 14% of single-stage and 6% of multistage approach patients (P < .001). After adjustment with a propensity score, multistage approach was associated with lower rates of 30-day/in-hospital mortality and/or permanent paraplegia (odds ratio, 0.466; 95% confidence interval, 0.271-0.801; P = .006) and higher patient survival at 1 year (86.9±1.3% vs 79.6±1.7%) and 3 years (72.7±2.1% vs 64.2±2.3%; adjusted hazard ratio, 0.714; 95% confidence interval, 0.528-0.966; P = .029), compared with a single stage approach.ConclusionStaging elective FB-EVAR of extent I to III TAAAs was associated with decreased risk of mortality and/or permanent paraplegia at 30 days or within hospital stay, and with higher patient survival at 1 and 3 years.
Published: 2023

10. Editor's Choice – PRINciples of optimal antithrombotiC therapy and coagulation managEment during elective fenestrated and branched EndovaScular aortic repairS (PRINCE2SS)

Author: Mario D’Oria, Luca Bertoglio, Angelo Antonio Bignamini, Kevin Mani, Tilo Kölbel, Gustavo Oderich, Roberto Chiesa, Sandro Lepidi, Said Abisi, Donald Adam, Michele Antonello, Martin Austermann, Adam W. Beck, Xavier Berard, Theodosios Bisdas, Dittmar Böckler, Jacob Budtz-Lilly, Stephen W.K. Cheng, Martin Czerny, Randall DeMartino, Nuno Dias, Konstantinos P. Donas, Matthew J. Eagleton, Mark A. Farber, Aaron Thomas Fargion, Marcelo Ferreira, Thomas L. Forbes, Mauro Gargiulo, Warren J. Gasper, Tomasz Jakimowicz, Stéphan Haulon, Joseph A. Hockley, Andrew Holden, Peter Holt, Andrea Kahlberg, Manar Khashram, Drosos Kotelis, Göran Lundberg, Thomas S. Maldonado, Nicola Mangialardi, Tara M. Mastracci, Blandine Maurel, Ross Milner, Bijan Modarai, Giuseppe Pannuccio, Gianbattista Parlani, Giovanni Pratesi, Raffaele Pulli, Raffi A. Qasabian, Michel M.P. J. Reijnen, Timothy Resh, Vincente Riambau, Nicla Settembre, Andres Schanzer, Andrej Schmidt, Darren Schneider, Geert Willem H. Schurink, Roberto Silingardi, Jonathan Sobocinski, Raphael Soler, Matthew P. Sweet, Glenn Wei Leong Tan, Emanuel R. Tenorio, Ignace F.J. Tielliu, Carlos H. Timaran, Yamume Tshomba, Nikolaos Tsilimparis, Wouter Van den Eynde, Thodur Vasudevan, Gian Franco Veraldi, Hence JM. Verhagen, Eric Verhoeven, Fabio Verzini, Anders Wanhainen, Alexander Zimmermann, and Surgery
Subjects: Anticoagulation, Antithrombotic, Antiplatelet, Branched, Delphi, Endovascular, Fenestrated, Pararenal, Thoraco-abdominal, Surgery, Cardiology and Cardiovascular Medicine
Abstract: Objective: Management of antithrombotic therapy in patients undergoing elective fenestrated branched endovascular aortic repair (F-BEVAR) is not standardised, nor are there any recommendations from current guidelines. By designing an international expert based Delphi consensus, the study aimed to create recommendations on the pre-, intra-, and post-operative management of antithrombotic therapy in patients scheduled for elective F-BEVAR in high volume centres.Methods: Eight facilitators created appropriate statements regarding the study topic that were voted on, using a four point Likert scale, by a selected panel of international experts using a three round modified Delphi consensus process. Based on the experts’ responses, only those statements reaching Grade A (full agreement ≥ 75%) or B (overall agreement ≥ 80% and full disagreement < 5%) were included in the final document. The round answers’ consistency was graded using Cohen's k, the intraclass correlation coefficient, and, in case of double re-submission, the Fleiss k.Results: Sixty-seven experts were included in the final analysis and voted the initial 43 statements related to pre- (n = 15), intra- (n = 10), and post-operative (n = 18) management of antithrombotic drugs. At the end of the process, six statements (13%) were rejected, 20 statements (44%) received a Grade B consensus, and 18 statements (40%) reached a Grade A consensus. Most statements (27; 71%) exhibited very high or high consistency grades, and 11 (29%) a fair or poor grading. The intra-operative statements mostly concentrated on threshold for and monitoring of proper heparinisation. The pre- and post-operative statements mainly focused on indications for dual antiplatelet therapy and its management, considering the possible need for cerebrospinal fluid drainage.Conclusion: Based on the elevated strength and high consistency of this international expert based Delphi consensus, most of the statements might guide current clinical management of antithrombotic therapy for elective F-BEVAR. Future studies are needed to clarify the debated issues.
Published: 2022

11. Doppler Ultrasound Monitoring of Echogenicity in Asymptomatic Subcritical Carotid Stenosis and Assessment of Response to Oral Supplementation of Vitamin K2 (PLAK2 Randomized Controlled Trial)

Author: Yamume Tshomba, Domenico Baccellieri, Niccolò Carta, Giuseppe Cilli, Vincenzo Ardita, Luca Apruzzi, Diletta Loschi, Andrea Kahlberg, Luca Bertoglio, Renata Castellano, Elisa Simonini, Felicita Andreotti, and Roberto Chiesa
Subjects: atherosclerosis, carotid stenosis, doppler ultrasound vitamin K2, gray scale median (GSM), plaque composition, Medicine (General), R5-920
Abstract: Background: Plaque composition may predict the evolution of carotid artery stenosis rather than its sole extent. The grey scale median (GSM) value is a reproducible and standardized value to report plaque echogenicity as an indirect measure of its composition. We monitored plaque composition in asymptomatic subcritical carotid stenosis and evaluated the effect of an oral modulating calcification factor (vitamin K2). Methods: Carotid plaque composition was assessed by GSM value. Monitoring the effects of standard therapy (acetylsalicylic acid and low–medium dosage statin) (acetylsalicylic acid (ASA) arm) or standard therapy plus vitamins K2 oral supplementation (ASA + K2 arm) over a 12 months period was conducted using an ultrasound scan in a prospective, open-label, randomized controlled trial (PLAK2). Results: Sixty patients on low–medium dosage statin therapy were enrolled and randomized (30 per arm) to either ASA + K2 or ASA alone. Thirty-seven patients (61.6%) showed at 12 months a stable plaque with a mean increase in the GSM value in respect to the baseline of 2.6% with no differences between the two study arms (p = 0.66). Fifteen patients (25%) showed an 8% GSM value reduction respect the baseline with no differences between the two study arms (p = 0.99). At multivariable analysis, the adjusted mean (95% confidence interval) GSM change per month from baseline was greater in the ASA + K2 arm (−0.55 points, p = 0.048) compared to ASA alone (−0.18 points, p = 0.529). Conclusions: Carotid plaque composition monitoring through GSM value represents a laborious procedure. Although its use may not be applied to everyday practice, a specific application consists in evaluating the effect of pharmacological therapy on plaque composition. This 12 months randomized trial showed that the majority of subcritical asymptomatic carotid plaque on treatment with low–medium dosage statin presented a stable or increased echogenicity. Although vitamin K2 beyond standard therapy did not determine a significant change in plaque composition, for those who presented with GSM reduction it did enhance a GSM monthly decline.
Published: 2021
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12. Mid-term results on a new self-expandable covered stent combined with branched stent-grafts: insights from a multicenter Italian registry

Author: Luca Bertoglio, Alessandro Grandi, Gian Franco Veraldi, Raffaele Pulli, Michele Antonello, Stefano Bonvini, Giacomo Isernia, Raffaello Bellosta, Francesco Buia, Roberto Silingardi, Angiletta Domenico, Chiesa Roberto, Di Marzo Luca, Flora Loris, Gennai Stefano, Giudice Rocco, Lenti Massimo, Leone Nicola, Lepidi Sandro, Melloni Andrea, Mezzetto Luca, Michelagnoli Stefano, Migliara Bruno, Milite Domenico, Pacini Davide, Palazzo Enzo, Pecchio Alberto, Pegorer Matteo Alberto, Perini Paolo, Piazza Michele, Pratesi Giovanni, Ronchey Sonia, Spadoni Nicola, Tusini Nicola, and Verzini Fabio
Subjects: Aorto-iliac aneurysm, Branched, Endovascular procedures, Thoracoabdominal Aortic Aneurysm, covered stent, instability, self-expandable, Covered stent, Instability, Self-expandable, Thoracoabdominal aortic aneurysm, Surgery, Cardiology and Cardiovascular Medicine
Published: 2023

13. European Multicentric Experience with Fenestrated-Branched ENDOvascular Stent-grafting after Previous FAILed Infrarenal Aortic Repair: the EU-FBENDO-FAIL Registry

Author: Jacob Budtz-Lilly, Mario D’Oria, Enrico Gallitto, Luca Bertoglio, Tilo Kölbel, David Lindström, Nuno Dias, Goran Lundberg, Dittmar Böckler, Gianbattista Parlani, Michele Antonello, Gian Franco Veraldi, Nikolaos Tsilimparis, Drosos Kotelis, Philip Dueppers, Giovanni Tinelli, Arnaldo Ippoliti, Paolo Spath, Antonino Logiacco, Geert Willem H. Schurink, Roberto Chiesa, Alessandro Grandi, Giuseppe Panuccio, Fiona Rohlffs, Anders Wanhainen, Kevin Mani, Angelos Karelis, Björn Sonesson, Magnus Jonsson, Alina-Marilena Bresler, Gioele Simonte, Giacomo Isernia, Andrea Xodo, Luca Mezzetto, Davide Mastrorilli, Carlota Fernandez Prendes, Basel Chaikouni, Alexander Zimmermann, Sandro Lepidi, Mauro Gargiulo, Barend Mees, Jon Unosson, MUMC+: MA Vaatchirurgie CVC (3), Vascular Surgery, and RS: Carim - V03 Regenerative and reconstructive medicine vascular disease
Subjects: Surgery
Abstract: OBJECTIVE: To report the mid-term outcomes of fenestrated-branched endovascular aneurysm repair (F-BEVAR) following a failed previous endovascular aneurysm repair (pEVAR) or previous open aneurysm repair (pOAR).METHODS: Data from consecutive patients who underwent F-BEVAR for pEVAR or pOAR from 2006-2021 from 17 European vascular centres were analyzed. Endpoints included technical success, major adverse events (MAE), 30-day mortality, and 5-year estimates of survival, target vessel primary patency, freedom from reinterventions, type I/III endoleaks, and sac growth >5 mm.SUMMARY BACKGROUND DATA: Treatment of a failed previous abdominal aortic aneurysm (AAA) repair is a complex undertaking. F-BEVAR is becoming an increasingly attractive option, although comparative data are limited regarding associated risk factors, indications for treatment, and various outcomes.RESULTS: There were 526 patients included, 268 pOAR and 258 pEVAR. Median time from previous repair to F-BEVAR was 7 (IQR, 4-12) years, 5 (3-8) for pEVAR and 10 (6-14) for pOAR, PCONCLUSIONS: Repair of a failed previous EVAR or OAR is safe and feasible with comparable technical success and survival rates. While successful treatment can be achieved, significant rates of reintervention should be anticipated, particularly for issues related to instability of target vessels/bridging stents.
Published: 2022

14. Peri-Operative Management of Patients Undergoing Fenestrated-Branched Endovascular Repair for Juxtarenal, Pararenal and Thoracoabdominal Aortic Aneurysms:Preventing, Recognizing and Treating Complications to Improve Clinical Outcomes

Author: Andrea Xodo, Mario D’Oria, Bernardo Mendes, Luca Bertoglio, Kevin Mani, Mauro Gargiulo, Jacob Budtz-Lilly, Michele Antonello, Gian Franco Veraldi, Fabio Pilon, Domenico Milite, Cristiano Calvagna, Filippo Griselli, Jacopo Taglialavoro, Silvia Bassini, Anders Wanhainen, David Lindstrom, Enrico Gallitto, Luca Mezzetto, Davide Mastrorilli, Sandro Lepidi, Randall DeMartino, Xodo, Andrea, D'Oria, Mario, Mendes, Bernardo, Bertoglio, Luca, Mani, Kevin, Gargiulo, Mauro, Budtz-Lilly, Jacob, Antonello, Michele, Veraldi, Gian Franco, Pilon, Fabio, Milite, Domenico, Calvagna, Cristiano, Griselli, Filippo, Taglialavoro, Jacopo, Bassini, Silvia, Wanhainen, Ander, Lindstrom, David, Gallitto, Enrico, Mezzetto, Luca, Mastrorilli, Davide, Lepidi, Sandro, and DeMartino, Randall
Subjects: Kardiologi, complications, outcome, review, Medicine (miscellaneous), Cardiac and Cardiovascular Systems, complication, aortic disease, outcomes, aortic aneurysm, fenestrated-branched endovascular repair
Abstract: The advent and refinement of complex endovascular techniques in the last two decades has revolutionized the field of vascular surgery. This has allowed an effective minimally invasive treatment of extensive disease involving the pararenal and the thoracoabdominal aorta. Fenestrated-branched EVAR (F/BEVAR) now represents a feasible technical solution to address these complex diseases, moving the proximal sealing zone above the renal-visceral vessels take-off and preserving their patency. The aim of this paper was to provide a narrative review on the peri-operative management of patients undergoing F/BEVAR procedures for juxtarenal abdominal aortic aneurysm (JAAA), pararenal abdominal aortic aneurysm (PRAA) or thoracoabdominal aortic aneurism (TAAA). It will focus on how to prevent, diagnose, and manage the complications ensuing from these complex interventions, in order to improve clinical outcomes. Indeed, F/BEVAR remains a technically, physiologically, and mentally demanding procedure. Intraoperative adverse events often require prolonged or additional procedures and complications may significantly impact a patient’s quality of life, health status, and overall cost of care. The presence of standardized preoperative, perioperative, and postoperative pathways of care, together with surgeons and teams with significant experience in aortic surgery, should be considered as crucial points to improve clinical outcomes. Aggressive prevention, prompt diagnosis and timely rescue of any major adverse events following the procedure remain paramount clinical needs.
Published: 2022

15. Complex Regional Pain Syndrome with Aortic Distress after Thoracic Endovascular Aortic Repair and False Lumen Exclusion with 'Candy Plug' Technique

Author: Renato Casana, Andrea Kahlberg, Riccardo Miloro, Santi Trimarchi, Luca Bertoglio, Valerio Tolva, Roberto Chiesa, Tolva, Valerio S, Kahlberg, Andrea, Bertoglio, Luca, Trimarchi, Santi, Miloro, Riccardo, Casana, Renato, and Chiesa, Roberto
Subjects: candy plug, medicine.medical_specialty, False lumen, Case Report, Aortic repair, aortic pain, Medicine, Radiology, Nuclear Medicine and imaging, aortic dissection, Acute aortic syndrome, Aortic dissection, Eighth intercostal space, TEVAR, business.industry, medicine.disease, Surgery, Distress, Complex regional pain syndrome, spinal cord protection, acute aortic syndrome, Cardiology and Cardiovascular Medicine, business, Oxycodone, visceral perfusion, medicine.drug
Abstract: A 41-year-old male presented for pain treated with oxycodone. A zone-2 thoracic endovascular aortic repair with distal PETTICOAT (provisional extension to induce complete attachment) for complicated Type-IIIB aortic dissection was performed 18 months before. Repeated hospitalizations did not show any issues to justify the recurrent pain. The aortic nature of the pain was suspected considering the plug as a pain trigger. Through a left thoracoabdominal incision in the eighth intercostal space, the candy plug was removed. Pain diminished after thoracoabdominal surgery steadily.
Published: 2021

16. Spinal Cord Ischemia After Thoracoabdominal Aortic Aneurysms Endovascular Repair: From the Italian Multicenter Fenestrated/Branched Endovascular Aneurysm Repair Registry.

Author: Rinaldi, Enrico, Melloni, Andrea, Gallitto, Enrico, Fargion, Aaron, Isernia, Giacomo, Kahlberg, Andrea, Bertoglio, Luca, Faggioli, Gianluca, Lenti, Massimo, Pratesi, Carlo, Gargiulo, Mauro, Melissano, Germano, Chiesa, Roberto, Luigi, Baccani, Luca, Bertoglio, Roberto, Chiesa, Gianluca, Faggioli, Aaron, Fargion, Cecilia, Fenelli, and Enrico, Gallitto
Abstract: Purpose: The aim of this study is to report an Italian multicenter experience analyzing the incidence and the risk factors associated with spinal cord ischemia (SCI) in a large cohort of thoracoabdominal aortic aneurysms (TAAAs) treated by fenestrated-branched endovascular aneurysm repair (F-/B-EVAR). Materials and Methods: All consecutive patients undergoing F-/B-EVAR in 4 Italian university centers between 2008 and 2019 were prospectively recorded and retrospectively analyzed. Spinal cord ischemia, 30 day/in-hospital adverse events, and mortality were assessed as early outcomes. Risk factors for SCI were determined by multivariable analysis. Results: A total of 351 patients received F-/B-EVAR for a TAAA. Twenty-eight (8.0%) patients died within 30 postoperative days or during the hospitalization. Regarding SCI, 47 patients (13.4%) developed neurological symptoms related to spinal cord impaired perfusion. Among them, 17 (4.8%) had a major permanent impairment. The multivariable analysis identified that SCI was associated with Crawford extent I to III (odds ratio [OR]: 20.90, p=0.004, 95% confidence interval [CI]=2.69–162.57), and with endovascular procedures performed for ruptured TAAA (OR: 5.74, p=0.010, 95% CI=1.53–21.57). Spinal cord ischemia was also significantly associated with a grade 3 bleeding during the visceral stage (OR: 4.34, p=0.005, 95% CI=1.55–12.16) and a grade 2 renal insufficiency at 30 days (OR: 7.45, p=0.002, 95% CI=2.12–26.18). Conclusion: The present study indicates that SCI is still an open issue after extent I to III TAAA endovascular repair, while its incidence in extent IV TAAA and pararenal/juxtarenal aneurysms is rare. Thoracoabdominal aortic aneurysms extension, urgent TAAA repair for rupture, severe bleeding, and 30 day renal insufficiency have been identified as significant risk factors for SCI. In the presence of such factors, adjunctive strategies may be considered to reduce SCI rates, while in low-risk patients invasive or potentially-risky maneuvers might not be justified. [ABSTRACT FROM AUTHOR]
Published: 2023
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17. Symptomatic superficial femoral artery pseudoaneurysm due to late stent fracture

Author: Alessandro Grandi, Roberto Chiesa, Luca Bertoglio, Vincenzo Ardita, Victor Bilman, Bilman, V., Ardita, V., Grandi, A., Chiesa, R., and Bertoglio, L.
Subjects: medicine.medical_specialty, Innovative technique, lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_treatment, lcsh:Surgery, 030204 cardiovascular system & hematology, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Pseudoaneurysm, 0302 clinical medicine, Stent removal, medicine, Stent, Fracture, Superficial artery, cardiovascular diseases, Surgical repair, business.industry, Superficial femoral artery, Saphenous vein bypass, lcsh:RD1-811, medicine.disease, equipment and supplies, Surgery, medicine.anatomical_structure, surgical procedures, operative, lcsh:RC666-701, Fracture (geology), cardiovascular system, Cardiology and Cardiovascular Medicine, business, Artery
Abstract: Late formation of pseudoaneurysm related to stent fracture is rarely described in the literature. We describe a case of spontaneous 8-cm femoral superficial artery pseudoaneurysm rupture that had developed from fracture of a stent implanted 3 years previously. Surgical repair was performed with fractured stent removal and reverse saphenous vein bypass. Keywords: Stent, Fracture, Superficial artery, Pseudoaneurysm
Published: 2020

18. Outcomes of 'Anterior Versus Posterior Divisional Branches of the Hypogastric Artery as Distal Landing Zone for Iliac Branch Devices': The International Multicentric R3OYAL Registry

Author: Mario D’Oria, Guilherme B. B. Lima, Nuno Dias, Giambattista Parlani, Mark Farber, Nikolaos Tsilimparis, Randall DeMartino, Carlos Timaran, Tilo Kolbel, Mauro Gargiulo, Ross Milner, Germano Melissano, Thomas Maldonado, Kevin Mani, Emanuel R. Tenorio, Gustavo S. Oderich, Angelos Karelis, Bjorn Sonesson, Sandro Lepidi, Gioele Simonte, Giacomo Isernia, Fernando Motta, Tugce Öz, Jan Stana, Bernardo Mendes, Carla Scott, Kirsten Haack, Enrico Gallitto, Antonino Logiacco, Trissa Babrowski, Luca Bertoglio, Alessandro Grandi, and Anders Wanhainen
Subjects: iliac branch, stent-graft, internal iliac artery, abdominal aortic aneurysm, endovascular repair, Radiology, Nuclear Medicine and imaging, Surgery, Cardiology and Cardiovascular Medicine, aortoiliac disease
Abstract: Objective: The aim of this multicentric registry was to assess the outcomes of “anteRior versus posteRior divisional bRanches Of the hYpogastric artery as distAl landing zone for iLiac branch devices (R3OYAL).” Methods: The main exposure of interest for the purpose of this study was the internal iliac artery (IIA) divisional branch (anterior vs posterior) that was used as distal landing zone. Early endpoints included technical success and adverse events. Late endpoints included survival, primary/secondary IIA patency, and IIA branch instability. Results: A total of 171 patients were included in the study, of which 50 received bilateral implantation of iliac branch devices (IBDs). This resulted in a total of 221 incorporated IIAs included in the final analysis, of which 40 were anterior divisional branches and 181 were posterior divisional branches. Technical success was high in both groups (anterior division: 98% vs posterior division: 100%, P = .18). Occurrence of any adverse event was noted in 14% of patients in both groups ( P = 1.0). The overall rate of freedom from the composite IBD branch instability did not show significant differences between patients receiving distal landing in the anterior or posterior division of the IIA at 3 years (79% vs 87%, log-rank test = .215). The 3-year estimates of IBD patency were significantly lower in patients who received distal landing in the anterior divisional branch than those who received distal landing in the posterior divisional branch (primary patency: 81% vs 96%, log-rank test = .009; secondary patency: 81% vs 97%, log-rank test < .001). Conclusions: The use of the anterior or posterior divisional branches of the IIA as distal landing zone for IBD implantation shows comparable profiles in terms of immediate technical success, perioperative safety, and side-branch instability up to 3 years. However, IBD patency at 3 years was higher when the distal landing zone was achieved within the posterior divisional branch of the IIA. Clinical Impact The results from this large multicentric registry confirm that use of the anterior or posterior divisional branches of the internal iliac artery (IIA) as distal landing zone for implantation of iliac branch devices (IBD) shows comparable profiles of safety and feasibility, thereby allowing to extend the indications for endovascular repair of aorto-iliac aneurysms to cases with unsuitable anatomy within the IIA main trunk. Although mid-term rates of device durability and branch instability seem to be similar, the rates of primary and secondary IBD patency at three years was favored when the distal landing zone was achieved in the posterior divisional branch of the IIA.
Published: 2022

19. Extrinsic outflow graft flow obstruction in patients with HeartMate3 LVAD

Author: Silvia Ajello, Marina Pieri, Luca Bertoglio, Savino Altizio, Pasquale Nardelli, and Anna Mara Scandroglio
Subjects: Biomaterials, outflow graft stenting, heart failure, HeartMate3, left ventricular assist device, Biomedical Engineering, Medicine (miscellaneous), Bioengineering, General Medicine
Published: 2022

20. Sex Influence on Fenestrated and Branched Endovascular Aortic Aneurysm Repair: Outcomes From a National Multicenter Registry

Author: Giacomo Isernia, Gioele Simonte, Enrico Gallitto, Luca Bertoglio, Aaron Fargion, Germano Melissano, Roberto Chiesa, Massimo Lenti, Carlo Pratesi, Gianluca Faggioli, and Mauro Gargiulo
Subjects: target artery/vessel/branch, thoracoabdominal aneurysm, BEVAR, abdominal aortic aneurysm, aneurysm, custom-made device, endovascular aneurysm repair, FEVAR, gender, thoracoabdominal aortic aneurysm, Radiology, Nuclear Medicine and imaging, Surgery, Cardiology and Cardiovascular Medicine
Abstract: Introduction: Women are generally underrepresented in trials focusing on aortic aneurysm. Nevertheless, sex-related differences have recently emerged from several studies and registries. The aim of this research was to assess whether sex-related anatomical disparities existed in fenestrated and branched aortic repair candidates and whether these discrepancies could influence endovascular repair outcomes. Methods: Data from all consecutive patients treated during the 2008–2019 period within the Italian Multicenter fenestrated or branched endovascular aortic repair (F/BEVAR) Registry were included in the present study. Propensity matching was performed using a logistic regression model adjusted for demographic data and comorbidities to obtain comparable male and female samples. The selection model led to a final study population of 176 patients (88 women and 88 men) among the total initial cohort of 596. Study endpoints were technical and clinical success, overall survival, aneurysm-related death, and reintervention rates evaluated at 30 days and during follow-up. Results: Twenty-eight patients (15.9%) received urgent/emergent repair. In most of the cases (71.6%), women received treatment for extensive thoracoabdominal pathology (Crawford type I, II, or III aneurysm rather than type IV or juxta-pararenal) versus 46.6% of men (p=0.001). Female patients presented with more challenging iliac accesses with at least one side considered hostile in 27.3% of the cases (vs 13.6% in male patients, p=0.039). Finally, women had significantly smaller visceral vessels. Women had significantly worse operative outcomes, with an 86.2% technical success rate versus 96.6% in the male population (p=0.016). No differences were recorded in terms of 30-day reinterventions between men and women. The 5-year estimate of freedom from late reintervention, according to Kaplan-Meier analysis, was 85.6% in men versus 81.6% in women (p=ns). No aneurysm-related death was recorded during follow-up (median observational time, 23 months [interquartile range, 7–45 months]). Conclusion: Women presented a significantly higher incidence of thoracoabdominal aneurysms, smaller visceral vessels, and more complex iliofemoral accesses, resulting in a significantly lower technical success after F/BEVAR. Further studies assessing sex-related differences are needed to properly determine the impact on outcomes and stratify procedural risks. Clinical Impact Women are generally underrepresented in trials focusing on aortic aneurysms. Aiming to assess whether sex may affect outcomes after a complex endovascular aortic repair, a propensity score selection was applied to a total population of 596 patients receiving F/BEVAR aortic repair with the Cook platform, matching each treated female patient with a corresponding male patient. Women presented more frequently a thoracoabdominal aneurysm extent, smaller visceral vessels, and complex iliofemoral accesses, resulting in significantly worse operative outcomes, with an 86.2% technical success versus 96.6% (p=0.016). No differences were recorded in terms of short-term and mid-term reinterventions. According to these results, careful and critical assessment should be posed in case of female patients receiving complex aortic repair, especially regarding preoperative anatomical evaluation and clinical selection with appropriate surgical risk stratification.
Published: 2022

21. Intraoperative neurophysiologic monitoring in thoracoabdominal aortic aneurysm surgery can provide real-time feedback for strategic decision making

Author: Francesca Bianchi, Marco Cursi, Heike Caravati, Calogera Butera, Luca Bosco, Fabrizio Monaco, Domenico Baccellieri, Luca Bertoglio, Andrea Kahlberg, Massimo Filippi, Germano Melissano, Roberto Chiesa, Ubaldo Del Carro, Bianchi, F., Cursi, M., Caravati, H., Butera, C., Bosco, L., Monaco, F., Baccellieri, D., Bertoglio, L., Kahlberg, A., Filippi, M., Melissano, G., Chiesa, R., and Carro, U. D.
Subjects: Throracoabdominal aortic aneurysm surgery, Aortic Aneurysm, Thoracic, Intraoperative Neurophysiological Monitoring, Decision Making, Compound motor action potentials, General Medicine, Evoked Potentials, Motor, Spinal cord ischemia, Motor evoked potentials, Feedback, Intraoperative neurophysiologic monitoring, Somatosensory evoked potentials, Neurology, Physiology (medical), Humans, Neurology (clinical), Retrospective Studies
Abstract: Objectives: Despite the introduction of several adjuncts to improve spinal perfusion, spinal cord ischemia (SCI) remains a devastating complication of thoracoabdominal aortic aneurysm (TAAA) repair. Our aim was to assess the effects on clinical outcome of interventions triggered by motor evoked potentials (MEP) alerts. Furthermore, we want to assess whether a multimodal intraoperative neurophysiologic monitoring (IONM) protocol is helpful for stratifying patients according to the risk of SCI at the end of the vascular phase of surgery. Methods: We prospectively studied one-hundred consecutive patients who underwent TAAA repair. We applied a multimodal IONM including MEP, somatosensory evoked potentials (SEP) and peripheral nerve monitoring techniques. Signal deteriorations were classified as reversible/irreversible according to whether they recovered or not at the end of monitoring (EOM), set at the end of the vascular phase of surgery. Significant MEP changes drove a series of corrective measures aimed to improve spinal perfusion. Results: The rate of immediate postoperative motor deficits consistent with SCI was significantly higher with irreversible MEP deteriorations compared to reversible ones. The interpretation of MEP findings at the EOM led to the development of risk categories for SCI, based on the association between MEP results and motor outcome. Conclusions: Our data seem to justify interventions made to reverse MEP deterioration in order to improve the clinical outcome. A multimodal IONM protocol could improve MEP interpretation at the end of the vascular phase of surgery, supporting the surgeon in their decision-making, before concluding vascular maneuvers.
Published: 2022

22. One-year results of the INSIGHT study on endovascular treatment of abdominal aortic aneurysms

Author: Giovanni Torsello, Luca Bertoglio, Richard Kellersmann, Jan J. Wever, Hans van Overhagen, Konstantinos Stavroulakis, Jean-Pierre Becquemin, Christoph Bühler, Roberto Chiesa, Enrico Cieri, Gioacchino Coppi, Mariano de Blas, Nuno Dias, Eric Ducasse, Ignacio Garcia, Mohamad Hamady, Arnaldo Ippoliti, Bob Knippenberg, Ralf Kolvenbach, Raghuram Lakshminarayan, Antonio Lorido, Dominique Midy, Nilo Mosquera, Alexander Oberhuber, Gabriele Pogany, Carlo Pratesi, Tim Resch, Vincenc Riambau, Håkan Roos, Jost Philipp Schäfer, Dierk Scheinert, Roberto Silingardi, Sherif Sultan, Fabio Verzini, Alessio Vona, Michiel Warlé, Marald Wikkeling, Jason Wilkins, Torsello, Giovanni, Bertoglio, Luca, Kellersmann, Richard, Wever, Jan J, van Overhagen, Han, and Stavroulakis, Konstantinos
Subjects: Male, Low-profile, Time Factors, Endoleak, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Myocardial Infarction, Prosthesis Design, Aortography, Infrarenal, Blood Vessel Prosthesis Implantation, Endovascular repair, Stent graft, 80 and over, Humans, Abdominal, Prospective Studies, Renal Insufficiency, Aged, Aged, 80 and over, Endovascular Procedures, Blood Vessel Prosthesis, Aortic Aneurysm, Stroke, Treatment Outcome, Surgery, Female, Stents, endovascular repair, infrarenal, low-profile, stent graft, Cardiology and Cardiovascular Medicine, Aortic Aneurysm, Abdominal
Abstract: Item does not contain fulltext OBJECTIVE: Endovascular repair of abdominal aortic aneurysms (AAAs) using the INCRAFT AAA Stent Graft System was safe and effective in regulatory approval studies. We herein report on the 1-year results of a real-world clinical study. METHODS: The INSIGHT study is a multi-center, prospective, open label, post-approval study conducted to continually evaluate the safety and performance of the INCRAFT System. Between 2015 and 2016, 150 consecutive patients with AAA at 23 centers in Europe were treated with the device in routine clinical practice. The primary endpoint was freedom from major adverse events (MAEs), namely death, myocardial infarction, cerebrovascular accident, and renal failure, within 30 days of the index procedure. End point data were assessed by a core laboratory. The secondary end points included technical success at the conclusion of the procedure and clinical success. RESULTS: All 150 patients studied (mean age, 73.6 ± 8.0 years; 89.3% men) met the primary end point without MAEs at 30-day follow-up. Technical success was achieved in 99.3% of patients without stent fractures at 30 days. Among the 146 patients eligible for 1-year follow-up, the MAE rate was 8.2% (ie, 12 patients suffered 13 MAEs: cerebrovascular accident in 8, myocardial infarction in 1, and 4 died, resulting in a 2.7% all-cause mortality rate). There were no reports of new onset renal failure requiring dialysis. Only 2.7% of patients had type I endoleak, and no type III endoleaks were identified through 1 year. The rate of clinical success at 1 year was 91.8%. CONCLUSIONS: The 1-year results of this multicenter real-world study underscore the safety and effectiveness of endovascular treatment of AAA with the INCRAFT System in routine clinical practice.
Published: 2022

23. Endovascular treatment of a triple paraanastomotic aneurysm after aortobiiliac reconstruction Tratamento endovascular de triplo aneurisma para-anastomótico após derivação aorto-biilíaca

Author: Alexandre Campos Moraes Amato, Andrea Kahlberg, Luca Bertoglio, Germano Melissano, and Roberto Chiesa
Subjects: Pseudo-aneurisma, cirurgia ilíaca e aórtica, reparo endovascular, tratamento endovascular, anastomose, complicações pós-operatórias, Pseudoaneurysm, aortic and iliac surgery, endovascular repair, endovascular treatment, anastomosis, postoperative complications, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: We report a case of a 72-year-old patient considered unfit for open surgery, presenting with paraanastomotic aneurysms of all three anastomoses, 13 years after an open aortobiiliac reconstruction for abdominal aortic aneurysm. This patient was successfully treated with an endovascular approach using a left aortouniiliac endograft and a right iliac tubular endograft, followed by crossover femorofemoral bypass. This report illustrates the usefulness of a minimally invasive approach for solving this complication of aortic open surgery and discusses technical issues related to endovascular devices in this particular setting.Relatamos um caso de um paciente de 72 anos não considerado elegível para cirurgia aberta, apresentando aneurismas para-anastomóticos das três anastomoses, 13 anos após uma reconstrução aberta aorto-biilíaca para aneurisma aórtico abdominal. Este paciente foi tratado com sucesso através de abordagem endovascular usando uma endoprótese aorto-uniilíaca esquerda e uma endoprótese tubular ilíaca direita, seguida por derivação cruzada fêmoro-femoral. Este relato ilustra a utilidade de uma abordagem minimamente invasiva para o tratamento desta complicação da cirurgia aórtica aberta e discute questões técnicas relacionadas a dispositivos endovasculares neste contexto em especial.
Published: 2008
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24. Endovascular treatment of aortic arch aneurysms Tratamento endovascular dos aneurismas de arco aórtico

Author: Roberto Chiesa, Germano Melissano, Yamume Tshomba, Efrem Civilini, Enrico Maria Marone, Luca Bertoglio, Fabio Massimo Calliari, and Bruno Di Bernardo
Subjects: Arco aórtico, tratamento endovascular, endoprótese, procedimento híbrido, Aortic arch, endovascular treatment, stent-graft, hybrid procedure, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: BACKGROUND: Endovascular approach to the aortic arch is an appealing solution for selected patients. OBJECTIVE: To compare the technical and clinical success recorded in the different anatomical settings of endografting for aortic arch disease. METHODS: Between June 1999 and October 2006, among 178 patients treated at our institution for thoracic aorta disease with a stent-graft, the aortic arch was involved in 64 cases. According to the classification proposed by Ishimaru, aortic zone 0 was involved in 14 cases, zone 1 in 12 cases and zone 2 in 38 cases. A hybrid surgical procedure of supra-aortic debranching and revascularization was performed in 37 cases. RESULTS: Zone 0. Proximal neck length: 44±6 mm. Initial clinical success was 78.6%: two deaths (stroke), one type Ia endoleak. At a mean follow-up of 16.4±11 months the midterm clinical success was 85.7%. Zone 1. Proximal neck length: 28±5 mm. Initial clinical success was 66.7%: 0 deaths, four type Ia endoleaks. At a mean follow-up of 16.9±17.2 months the midterm clinical success was 75.0%. Zone 2. Proximal neck length: 30±5 mm. Initial clinical success was 84.2%: two deaths (one cardiac arrest, one multiorgan embolization), three type Ia endoleaks, one case of open conversion. Two cases of delayed transitory paraparesis/paraplegia were observed. At a mean follow-up of 28.0±17.2 months the midterm clinical success was 89.5%. CONCLUSIONS: This study and a literature review demonstrated that hybrid procedure for aortic arch pathology is feasible in selected patients at high risk for conventional surgery. Our experience is still limited by the relatively small sample size. We propose to reserve zone 1 for patients unfit for sternotomy or in cases with aortic neck length > 30 mm following left common carotid artery debranching. We recommend to perform complete aortic rerouting of the aortic arch in cases with lesser comorbidities and shorter aortic neck.CONTEXTO: O tratamento endovascular dos aneurismas do arco aórtico é uma solução interessante para pacientes selecionados. OBJETIVO: Comparar os sucessos técnico e clínico registrados nas diferentes regiões anatômicas do arco aórtico após a colocação de endoprótese. MÉTODOS: Entre junho de 1999 e outubro de 2006, 178 pacientes foram tratados na nossa instituição devido a doenças da aorta torácica com a colocação de endoprótese, sendo que o arco aórtico estava envolvido em 64 casos. De acordo com a classificação proposta por Ishimaru, a zona aórtica 0 estava envolvida em 14 casos, zona 1 em 12 casos e zona 2 em 38 casos. Procedimentos de debranching do arco aórtico e revascularização extra-anatômica dos troncos supra-aórticos foram realizados em 37 casos para obter um adequado colo aórtico proximal. RESULTADOS: Zona 0. Comprimento do colo proximal: 44±6 mm. Sucesso clínico inicial de 78,6%: dois óbitos (acidente vascular cerebral), um vazamento do tipo Ia. Seguimento médio de 16,4±11 meses com sucesso clínico a médio prazo de 85,7%. Zona 1. Comprimento do colo proximal: 28±5 mm. Sucesso clínico inicial de 66,7%: 0 óbitos, quatro vazamentos do tipo Ia. Seguimento médio de 16,9±17,2 meses com sucesso clínico a médio prazo de 75%. Zona 2. Comprimento do colo proximal: 30±5 mm. Sucesso clínico inicial de 84,2%: dois óbitos (um infarto cardíaco e uma embolização de múltiplos órgãos), três vazamentos do tipo Ia, um caso de conversão para operação aberta. Dois casos de paraparesia/paraplegia transitória tardia foram observados. Seguimento médio de 28,0±17,2 meses com sucesso clínico a médio prazo de 89,5%. CONCLUSÃO: Este estudo e a análise da literatura demonstram que o procedimento híbrido para moléstia do arco aórtico é factível em pacientes selecionados com alto risco para a operação convencional. Nossa experiência ainda é limitada pelo tamanho relativamente pequeno da amostra. Sugerimos reservar a zona 1 para pacientes inadequados para esternotomia ou em casos de comprimento do colo aórtico proximal > 30 mm apos revascularização da artéria carótida comum esquerda. Sugerimos realizar revascularização completa do arco aórtico em pacientes adequados com um colo aórtico proximal mais curto.
Published: 2008
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25. Contemporary Results of Carotid Artery Stenting Using Low-Profile Dual-Metal Layer Nitinol Micromesh Stents in Relation to Single-Layer Carotid Stents

Author: Luca Bertoglio, Andrea Kahlberg, Daniele Mascia, Vincenzo Ardita, Victor Bilman, Roberto Chiesa, Germano Melissano, Enrico Rinaldi, Kahlberg, Andrea, Bilman, Victor, Ardita, Vincenzo, Mascia, Daniele, Bertoglio, Luca, Rinaldi, Enrico, Melissano, Germano, and Chiesa, Roberto
Subjects: medicine.medical_specialty, Carotid arteries, medicine.medical_treatment, carotid artery disease, Casper stent, Roadsaver stent, carotid stenosis, carotid stenting, dual-layer stent, micromesh, stents, stroke, Risk Factors, Carotid artery disease, Alloys, medicine, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Stroke, Retrospective Studies, business.industry, Stent, Perioperative, medicine.disease, Carotid Arteries, Treatment Outcome, Surgery, Radiology, Carotid stenting, Cardiology and Cardiovascular Medicine, business, Single layer, Carotid stents
Abstract: Purpose: To evaluate patients characteristics, procedural details, perioperative outcomes, and midterm results of carotid artery stenting (CAS) performed with the Roadsaver/Casper stent (Terumo Corp, Tokyo, Japan) as compared to concurrent patients treated with other commercially available carotid stents. Materials and Methods: This is a single-center, retrospective, nonrandomized study including 200 consecutive patients who underwent a total of 205 elective CAS procedures due to severe internal carotid artery stenosis between April 2015 and December 2018. Procedural data and outcomes for patients treated with the Roadsaver/Casper stent implantation (100 procedures, in 97 patients) vs first-generation carotid stents implantations (90 procedures, in 88 patients) were compared. Fifteen patients were treated with CGuard carotid stent (InspireMD, Tel Aviv, Israel), and outcomes were reported separately. Primary endpoints were the occurrence of major adverse cerebrovascular events (MACE), including death, ipsilateral stroke, and transitory ischemic attack (TIA). Secondary endpoints were the rate of intrastent stenosis, the need for reintervention, and the occurrence of adverse cardiovascular events, including myocardial infarction, arrhythmias, and need for inotropic support. Results: No difference in demographics and preoperative risk factors were observed between patients treated with and without the Roadsaver/Casper stent. The mean procedure time was shorter in the Roadsaver/Casper group (40.7±16.9 vs 49.4±27.3 minutes; p=0.008), while radial percutaneous access was more frequent (24% vs 5%; pConclusions: In this real-world cohort of patients undergoing CAS, the Roadsaver/Casper stent was used to treat more symptomatic and vulnerable carotid plaques as compared to other carotid stents. Nevertheless, patients treated with this low-profile dual-layer micromesh stent showed low events rates at both 30 days and follow-up, similar to that observed for other stents.
Published: 2021

26. Is the Munich Valsalva Implantation Technique (MuVIT) the One-Size-Fits-All Maneuver for Cardiac Output Reduction During TEVAR?

Author: Fabrizio Monaco, Gaia Barucco, Luca Bertoglio, Monaco, F., Barucco, G., and Bertoglio, L.
Subjects: medicine.medical_specialty, Cardiac output, business.industry, Valsalva Maneuver, Endovascular Procedures, Blood Pressure, Cardiac Output, Humans, Treatment Outcome, Reduction (complexity), Internal medicine, medicine, Cardiology, Radiology, Nuclear Medicine and imaging, Surgery, Cardiology and Cardiovascular Medicine, business
Published: 2021

27. Incidence of deep venous thrombosis in COVID-19 hospitalized patients during the first peak of the Italian outbreak

Author: Luca Apruzzi, Patrizia Rovere Querini, Alberto Zangrillo, Armando D'Angelo, Vincenzo Ardita, Domenico Baccellieri, Enrico Rinaldi, Roberto Chiesa, Fabio Ciceri, Germano Melissano, Victor Bilman, Stefania Calvisi, Giovanni Landoni, Moreno Tresoldi, Francesco De Cobelli, Antonella Castagna, Luca Bertoglio, Matteo Bossi, Laura Galli, Baccellieri, Domenico, Bertoglio, Luca, Apruzzi, Luca, Ardita, Vincenzo, D'Angelo, Armando, Bossi, Matteo, Rinaldi, Enrico, Bilman, Victor, Calvisi, Stefania, Castagna, Antonella, Galli, Laura, Landoni, Giovanni, Melissano, Germano, Querini, Patrizia Rovere, Tresoldi, Moreno, De Cobelli, Francesco, Zangrillo, Alberto, Ciceri, Fabio, and Chiesa, Roberto
Subjects: Male, Pediatrics, medicine.medical_specialty, pulmonary embolism, Coronavirus disease 2019 (COVID-19), Hospitalized patients, duplex ultrasound, Deep vein, Population, 030204 cardiovascular system & hematology, heparin, Disease Outbreaks, 03 medical and health sciences, 0302 clinical medicine, Deep vein thrombosi, Deep vein thrombosis, medicine, Humans, 030212 general & internal medicine, education, Aged, Retrospective Studies, Venous Thrombosis, education.field_of_study, business.industry, SARS-CoV-2, Incidence (epidemiology), Incidence, prophylaxi, Outbreak, COVID-19, General Medicine, Middle Aged, medicine.disease, Thrombosis, Hospitalization, Venous thrombosis, medicine.anatomical_structure, Italy, prophylaxis, Female, Cardiology and Cardiovascular Medicine, business
Abstract: Objectives A high rate of thrombotic events has been reported in COVID-19 population. The study aims to assess the incidence of deep vein thrombosis (DVT) in COVID-19 patients admitted to a single tertiary hospital. Methods From April 2nd to April 18th, 2020, hospitalized patients with SARS-CoV-2 infection were screened by lower limb duplex ultrasound (DUS). Patients were on (low molecular weight heparin) LMWH prophylaxis in medical wards, and on therapeutic anticoagulation in intensive care unit (ICU). DVT risk factors, reported by the Padua prediction score and blood tests, were retrieved from institutional electronic charts. The study primary endpoint was the incidence of DVT in the in-hospital COVID-19 population and its association with clinical and laboratory risk factors. The secondary endpoint was the association of DVT with mortality. Results Two hundred patients (median age 62 years, 72% male, 40 in ICU) received DUS screening. DVT was observed in 29 patients (14.5%), with proximal extension in 16 patients, and in association with symptoms in four patients. The DVT rate was similar in ICU (12.5%) and non-ICU patients (15%). Eighty-seven patients underwent a computed tomography angiography (CTA) that showed pulmonary embolism in 35 patients (40.2%) not associated with DVT in 25/35 cases (71.4%). DVT in the ten patients with pulmonary embolism were symptomatic in four and with a proximal localization in eight cases. A D-dimer level ≥5 mg/l at admission was predictive of DVT (OR 1.02; IC95% 1.03-1.16; p = .003). At the multivariate analysis in-hospital mortality was predicted by age (OR 1.06; 95% CI 0.02-1.15; p = .004) and by being an ICU patient (OR 1.23; 95% CI 0.30-2.25; p = .01). Conclusions Despite LMWH prophylaxis or full anticoagulant therapy, the incidence of DVT, mainly asymptomatic, in hospitalized COVID-19 patients was 14.5%. Further research should focus on the appropriate antithrombotic therapy for COVID-19 patients.
Published: 2021

28. Endovascular embolization of a lower limb arteriovenous fistula using a vascular plug deployed with a through-and-through arteriovenous access

Author: Alessandro Grandi, Andrea Melloni, Roberto Chiesa, Luca Bertoglio, Grandi, A., Melloni, A., Chiesa, R., and Bertoglio, L.
Subjects: Male, medicine.medical_specialty, Percutaneous, Popliteal fossa, medicine.medical_treatment, Pulsatile flow, Arteriovenous fistula, popliteal, 030204 cardiovascular system & hematology, 03 medical and health sciences, plug, 0302 clinical medicine, Medicine, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, 030212 general & internal medicine, Embolization, arteriovenous fistula, through-and-through, Aged, medicine.diagnostic_test, business.industry, General Medicine, Auscultation, medicine.disease, Embolization, Therapeutic, Surgery, body regions, Femoral Artery, post-traumatic, medicine.anatomical_structure, Treatment Outcome, medicine.vein, Lower Extremity, Arteriovenous Fistula, Posterior tibial vein, Cardiology and Cardiovascular Medicine, business, Through and through
Abstract: A 66-year-old man was referred to our institution for a popliteal arteriovenous fistula (AVF). The patient presented with left lower limb edema associated with a pulsatile popliteal mass with bruit at auscultation, and no sign of lower limb ischemia. Relevant history included penetrating stabbing wound to that leg 50 years prior. A computed tomography scan demonstrated an AVF with a tract 10 mm in length and 6 mm in diameter at the level of the popliteal fossa. An AMPLATZER Vascular Plug III 12 mm (AVP - AGA Medical Corporation, Minneapolis, MN) was initially deployed through a percutaneous femoral arterial access. Initial angiographic check showed inadequate sealing, so the plug was repositioned from the venous side of the AVF with a through-and-through arteriovenous access from the posterior tibial vein, achieving a correct sealing. At 24-month follow-up the patient does not present any complications from the procedure, and the AVF remains occluded.
Published: 2021

29. Intravascular Ultrasound Imaging and Endovascular Treatment of Left Ventricle Assist Device (HM3) Outflow Graft Obstruction

Author: Alberto Zangrillo, Luca Bertoglio, Silvia Ajello, Anna Mara Scandroglio, Diletta Loschi, Americo Peña, Luca Apruzzi, Savino Altizio, Apruzzi, Luca, Altizio, Savino, Loschi, Diletta, Bertoglio, Luca, Peña, Americo, Ajello, Silvia, Zangrillo, Alberto, and Scandroglio, Anna Mara
Subjects: Heart Failure, medicine.medical_specialty, HM3, medicine.diagnostic_test, business.industry, Heart Ventricles, endovascular procedures, outflow obstruction, intravascular ultrasound, Treatment Outcome, medicine.anatomical_structure, Ventricle, Intravascular ultrasound, medicine, Humans, Outflow, Heart-Assist Devices, Radiology, Endovascular treatment, Cardiology and Cardiovascular Medicine, business, Ultrasonography, Interventional
Published: 2021

30. Role of historical and procedural staging during elective fenestrated and branched endovascular treatment of extensive thoraco-abdominal aortic aneurysms

Author: Chiesa Roberto, Pratesi Carlo, Gargiulo Mauro, Aaron Fargion, Luca Bertoglio, Fargion Aaron, Melloni Andrea, Gianluca Faggioli, Bertoglio Luca, Isernia Giacomo, Lenti Massimo, Giacomo Isernia, Roberto Chiesa, Mascoli Chiara, Fenelli Cecilia, Simonte Gioele, Speziali Sara, Massimo Lenti, Kahlberg Andrea, Andrea Kahlberg, Pini Rodolfo, Rinaldi Enrico, Gallitto Enrico, Mauro Gargiulo, Germano Melissano, Baccani Luigi, Melissano Germano, Carlo Pratesi, Logiacco Antonino, Enrico Gallitto, Faggioli Gianluca, Bertoglio, Luca, Kahlberg, Andrea, Gallitto, Enrico, Fargion, Aaron, Isernia, Giacomo, Faggioli, Gianluca, Melissano, Germano, Lenti, Massimo, Pratesi, Carlo, Gargiulo, Mauro, and Chiesa, Roberto
Subjects: Male, medicine.medical_specialty, spinal cord ischemia, Aortic aneurysm, Blood Vessel Prosthesis Implantation, Postoperative Complications, paraplegia, Risk Factors, Occlusion, medicine, Clinical endpoint, Humans, procedures, Endovascular treatment, Aged, Retrospective Studies, Aortic Aneurysm, Thoracic, Aortic Aneurysm, Thoracoabdominal, endovascular, business.industry, Endovascular Procedures, Spinal cord ischemia, Vascular surgery, medicine.disease, Surgery, Stenosis, Treatment Outcome, Female, Cardiology and Cardiovascular Medicine, business, Paraplegia
Abstract: Procedural staging is often performed to reduce the incidence of spinal cord ischemia (SCI) during endovascular treatment of extensive thoracoabdominal aortic aneurysms (TAAAs). However, its role in the case of previous thoracic or infrarenal aortic repair (historical staging) has been controversial. In the present study, we evaluated the SCI rates when procedural staging was routinely used and studied its potential benefits when previous aortic repairs had already been performed.The data from patients treated electively with fenestrated/branched endovascular aortic repair for extent I, II, III, and V TAAAs were retrieved from a multicenter registry (four high-volume national teaching hospitals) and analyzed. The primary endpoint was the rate of SCI and its association with preoperative and postoperative variables, including historical staging, procedural staging, and an impaired collateral network (subclavian or hypogastric stenosis75% per occlusion). Variables were defined in accordance with the Society for Vascular Surgery reporting standards. A logistic regression model with stepwise selection was used to identify the predictors of SCI.A total of 240 patients (76% male; median age, 73 years) were analyzed. Of the 240 patients, 43 (18%) had presented with an impaired collateral network, 136 (57%) had had historical staging, and 157 (65%) had received procedural staging. Preoperative spinal fluid cerebrospinal drainage was performed in 130 patients (54%). Permanent grade 3 SCI was observed in 13 patients (5%) and was negatively affected by both an impaired collateral network (odds ratio [OR], 17.3; 95% confidence interval [CI], 1.7-176; P = .016) and the presence of bilateral iliac occlusive disease (OR, 10.1; 95% CI, 1.1-98.3; P = .046). Both historical (OR, 0.02; 95% CI, 0.001-0.46; P = .014) and procedural (OR, 0.01; 95% CI, 0.02-0.7; P = .019) staging mitigated the permanent SCI rates. The need for postoperative transfusions (OR, 1.4; 95% CI, 1.1-1.8; P = .014) and the occurrence of postoperative renal complications (OR, 6.5; 95% CI, 1.2-35.0; P .001) were associated with the development of SCI. Among the patients with historical staging, no further benefit from procedural staging was observed (SCI with procedural staging, 1%; vs no staging, 2%; P = NS).For patients with extensive TAAAs treated with fenestrated/branched endovascular aortic repair, both historical and planned procedural staging were associated with reduced permanent SCI rates. However, no additional benefit was observed when procedural staging was performed in patients with historical staging and an intact collateral network. The protective role of preoperative cerebrospinal fluid drainage placement requires further investigation.
Published: 2021

31. Symptomatic internal carotid artery dissection and kinking in a patient with fibromuscular dysplasia

Author: Luca Apruzzi, Luca Bertoglio, Francesca Sanvito, Roberto Chiesa, Domenico Baccellieri, Victor Bilman, Bilman, V., Apruzzi, L., Baccellieri, D., Sanvito, F., Bertoglio, L., and Chiesa, R.
Subjects: medicine.medical_specialty, RD1-811, Case Report, Dissection (medical), Fibromuscular dysplasia, 030204 cardiovascular system & hematology, dissecção arterial, displasia fibromuscular, Carotid artery dissection, acotovelamento, 03 medical and health sciences, 0302 clinical medicine, medicine.artery, medicine, Diseases of the circulatory (Cardiovascular) system, enrolamento, artéria carótida, Coiling, Internal carotid artery dissection, Arterial dissection, business.industry, Great saphenous vein, medicine.disease, Kinking, medicine.anatomical_structure, RC666-701, cardiovascular system, Carotid artery, Surgery, Radiology, Internal carotid artery, Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery, Artery
Abstract: Isolated dissection of the internal carotid artery (ICA) is rare in young patients and is a cause for strong suspicion of fibromuscular dysplasia (FMD), especially when associated with artery elongation and tortuosity. The natural history of cerebrovascular FMD is unknown and management of symptomatic patients can be challenging. We report the case of a 44-year-old female patient with a history of transient ischemic attack in the absence of cardiovascular risk factors, associated with an isolated left ICA dissection and kinking. Carotid duplex ultrasound confirmed the diagnosis of dissection and demonstrated severe stenosis of the left ICA. The patient underwent surgical repair and histopathological evaluation confirmed the diagnosis of FMD with dissection. An autogenous great saphenous vein bypass was performed and the patient had an uneventful recovery. Cervical carotid artery dissection can be related to underlying arterial pathologies such as FMD, and the presence of ICA tortuosity highlights certain peculiarities for optimal management, which might be surgical.
Published: 2021

32. Percutaneous Mechanical Thrombectomy of Atriocaval Floating Thrombus After Impella RP Removal in a Critically Ill Patient

Author: Silvia Ajello, Luca Bertoglio, Mara Scandroglio, Domenico Baccellieri, Luca Apruzzi, Matteo Bossi, Fabrizio Monaco, Apruzzi, L., Bossi, M., Monaco, F., Bertoglio, L., Ajello, S., Scandroglio, M., and Baccellieri, D.
Subjects: Inferior, medicine.medical_specialty, Percutaneous, Vena Cava, Deep vein, Critical Illness, advanced cardiac life support, critical care, inferior vena cava, thrombectomy, thrombosis, Humans, Middle Aged, Thrombectomy, Pulmonary Embolism, Thrombosis, Vena Cava, Inferior, 030204 cardiovascular system & hematology, Inferior vena cava, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, medicine, cardiovascular diseases, Thrombus, Impella, business.industry, Cardiogenic shock, medicine.disease, Surgery, Pulmonary embolism, Anesthesiology and Pain Medicine, medicine.anatomical_structure, medicine.vein, cardiovascular system, Cardiology and Cardiovascular Medicine, business
Abstract: The rapid institution of mechanical circulatory support (MCS) during cardiogenic shock secondary to severe biventricular failure is strongly recommended. Despite the introduction of less-invasive devices and adequate anticoagulation protocols, the presence of vascular complications in patients treated with MCS has not yet been eliminated. Here, the authors report a 60-year-old patient treated with the Bi-Pella approach for biventricular failure. Despite anticoagulant therapy, the patient developed a floating thrombosis in the inferior vena cava extending to the right atrium after the Impella RP removal. Considering the thrombus instability and the risk of pulmonary embolism, the patient was treated urgently for a percutaneous mechanical thrombectomy using the AngioJet thrombectomy system. The procedure was completed without intraoperative complications, and both the completion angiography and transesophageal echocardiography showed complete thrombus removal. No procedure-related complications occurred, but the patient died from progressive worsening of left ventricular failure on the 16th postoperative day. In the case of proximal extensive deep vein thrombosis with an increased risk of pulmonary embolism, the use of percutaneous mechanical thrombectomy could be a therapeutic option, even in critically ill patients, due to its minimally invasive nature and low rates of complications.
Published: 2021

33. Learning curve, patient selection and new technique for branched endovascular aortic arch repair

Author: Roberto Chiesa, Luca Bertoglio, Bertoglio, L., and Chiesa, R.
Subjects: Pulmonary and Respiratory Medicine, Aortic arch, medicine.medical_specialty, Cerebral, Thoracic, Aorta, Thoracic, Arch, Branched, Endovascular, Stroke, Blood Vessel Prosthesis, Humans, Learning Curve, Patient Selection, Aorta, Aortic Aneurysm, Internal medicine, medicine.artery, Medicine, Selection (genetic algorithm), Aortic Aneurysm, Thoracic, business.industry, General Medicine, medicine.disease, Cardiology, Surgery, Cardiology and Cardiovascular Medicine, business
Published: 2021

34. Renal perfusion with histidine-tryptophan-ketoglutarate compared with Ringer's solution in patients undergoing thoracoabdominal aortic open repair

Author: Andrea Kahlberg, Yamume Tshomba, Domenico Baccellieri, Luca Bertoglio, Enrico Rinaldi, Vincenzo Ardita, Elisa Colombo, Umberto Moscato, Germano Melissano, Roberto Chiesa, Luca Apruzzi, Samuele Bossi, Renata Castellano, Barbara Catenaccio, Angela Maria Ferrante, Giovanni Landoni, Rosalba Lembo, Pasquale Nardelli, Laura Pasin, Elisa Simonini, Massimo Venturini, University of Zurich, Kahlberg, Andrea, Kahlberg, A., Tshomba, Y., Baccellieri, D., Bertoglio, L., Rinaldi, E., Ardita, V., Colombo, E., Moscato, U., Melissano, G., Chiesa, R., Apruzzi, L., Bossi, S., Castellano, R., Catenaccio, B., Ferrante, A. M., Landoni, G., Lembo, R., Nardelli, P., Pasin, L., Simonini, E., and Venturini, M.
Subjects: Pulmonary and Respiratory Medicine, enriched Ringer's, Renal function, chronic kidney disease stage, 610 Medicine & health, 030204 cardiovascular system & hematology, 2705 Cardiology and Cardiovascular Medicine, Histidine-tryptophan-ketoglutarate, 03 medical and health sciences, Aortic aneurysm, chemistry.chemical_compound, 10180 Clinic for Neurosurgery, 0302 clinical medicine, Interquartile range, acute kidney injury, Custodiol solution, thoracoabdominal aortic aneurysm, Medicine, Creatinine, business.industry, Acute kidney injury, medicine.disease, Settore MED/22 - CHIRURGIA VASCOLARE, 2746 Surgery, 030228 respiratory system, chemistry, 2740 Pulmonary and Respiratory Medicine, Anesthesia, Surgery, Ringer's solution, Cardiology and Cardiovascular Medicine, business, Perfusion
Abstract: Objective The objective of this study was to compare the efficacy of renal perfusion with Custodiol (Dr Franz-Kohler Chemie GmbH, Bensheim, Germany) versus enriched Ringer's solution for renal protection in patients undergoing open thoracoabdominal aortic aneurysm (TAAA) repair. Methods Ninety consecutive patients scheduled for elective open TAAA repair were enrolled between 2015 and 2017 in a single-center, phase IV, prospective, parallel, randomized, double-blind trial (the CUstodiol versus RInger: whaT Is the Best Agent [CURITIBA] trial), and randomized to renal arteries perfusion with 4°C Custodiol (Dr Franz-Kohler Chemie GmbH, Bensheim, Germany; n = 45) or 4°C lactated Ringer's solution (n = 45). The incidence of acute kidney injury (AKI) in patients undergoing TAAA open surgery using Custodiol renal perfusion versus an enriched Ringer's solution was the primary end point. Results Ninety patients completed the study (45 patients in each group). The incidence of postoperative AKI was significantly lower in the Custodiol group (48.9% vs 75.6%; P = .02). In the multivariable model, only the use of Custodiol solution resulted as protective from the occurrence of any AKI (odds ratio, 0.230; 95% confidence interval, 0.086-0.614; P = .003), whereas TAAA type II extent was associated with the development of severe AKI (odds ratio, 4.277; 95% confidence interval, 1.239-14.762; P = .02). At 1-year follow-up, serum creatinine was not significantly different from the preoperative values in both groups. Conclusions The use of Custodiol during open TAAA repair was safe and resulted in significantly lower rates of postoperative AKI compared with Ringer's solution. These findings support safety and efficacy of Custodiol in this specific setting, which is currently off-label.
Published: 2021

35. Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study

Author: Dmitri, Nepogodiev, Joana Ff Simoes, Elizabeth, Li, Maria, Picciochi, James, C Glasbey, Glauco, Baiocchi, Ruth, Blanco-Colino, Daoud, Chaudhry, Ehab, Alameer, Kariem, El-Boghdadly, Funmilola, Wuraola, Dhruva, Ghosh, Rohan, R Gujjuri, Ewen, M Harrison, Herman, Lule, Haytham, Kaafarani, Mohammad, Khosravi, Irmgard, Kronberger, Sezai, Leventoğlu, Harvinder, Mann, Kenneth, A Mclean, Mengistu Gebreyohanes Mengesha, Maria Marta Modolo, Faustin, Ntirenganya, Lisa, Norman, Oumaima, Outani, Riinu, Pius, Peter, Pockney, Ahmad Uzair Qureshi, April Camilla Roslani, Sohei, Satoi, Catherine, Shaw, Aneel, Bhangu, Omar, M Omar, Waheed-Ul-Rahman, Ahmed, Leah, Argus, Alasdair, Ball, Edward, P Bywater, Amanpreet, Brar, Brett, E Dawson, Irani, Duran, Muhammed, Elhadi, Conor, S Jones, Sivesh, K Kamarajah, James, M Keatley, Samuel, Lawday, Ella, J Marson, Riinu, Ots, Irène, Santos, Elliott, H Taylor, Isobel, M Trout, Chris, Varghese, Mary, L Venn, William, Xu, Irida, Dajti, Arben, Gjata, Salah Eddine Oussama Kacimi, Luis, Boccalatte, Daniel, Cox, Philip, Townend, Felix, Aigner, Irmgard Elisabeth Kronberger, Elgun, Samadov, Amer, Alderazi, Kamral, Hossain, Greg, Padmore, Gabrielle van Ramshorst, Ismaïl, Lawani, Anis, Cerovac, Samir, Delibegovic, Gustavo Mendonça Ataíde Gomes, Igor Lima Buarque, Muhammad, Gohar, Mihail, Slavchev, Chukwuemeka, Nwegbu, Arnav, Agarwal, Janet, Martin, Joshua, Ng-Kamstra, Maricarmen, Olivos, Wenhui, Lou, Dong-Lin, Ren, Jose Andres Calvache, Carlos, J Perez Rivera, Ana Danic Hadzibegovic, Tomislav, Kopjar, Jakov, Mihanovic, Pablo Mijahil Avilés Jiménez, Nikolaos, Gouvas, Jaroslav, Klat, René, Novysedlák, Nicolas, Amisi, Peter, Christensen, Alaa, El-Hussuna, Sylvia, Batista, Eddy, Lincango-Naranjo, Sameh, Emile, Danilo Alfonso Arévalo Sandoval, Hailu, Dhufera, Samuel, Hailu, Mengistu, G Mengesha, Joonas, H Kauppila, Alexis, P Arnaud, Zaza, Demetrashvili, Markus, Albertsmeier, Hans, Lederhuber, Markus, W Löffler, Daniel Kwesi Acquah, Bernard, Ofori, Stephen, Tabiri, Symeon, Metallidis, Georgios, Tsoulfas, Maria-Lorena, Aguilera-Arevalo, Gustavo, Recinos, Tamás, Mersich, Dániel, Wettstein, Gabriele, Kembuan, Peiman Brouki Milan, Mohammad Hossein Khosravi, Masoud, Mozafari, Ahmed, Hilmi, Helen, Mohan, Oded, Zmora, Gaetano, Gallo, Francesco, Pata, Gianluca, Pellino, Yuki, Fujimoto, Naoto, Kuroda, Mohamad, K Abou Chaar, Faris, Ayasra, Ildar, Fakhradiyev, Intisar Hisham Said Hamdun, Jang, Jin-Young, Mohammad, Jamal, Lina, Karout, Aiste, Gulla, Fanjandrainy, Rasoaherinomenjanahary, Luc Hervé Samison, Iran Irani Durán Sánchez, Diana Samantha Gonzalez, Laura, Martinez, María José Martínez, Alejandra, Nayen, Antonio Ramos-De la Medina, Jade, Nunez, Pueya Rashid Nashidengo, Rakesh, Shah, Ashish Lal Shrestha, Pascal, Jonker, Schelto, Kruijff, Milou, Noltes, Pieter, Steinkamp, Deborah, Wright, Lukman, Abdur-Rahman, Adesoji, Ademuyiwa, Adewale, Adisa, Babatunde, Osinaike, Justina, Seyi-Olajide, Omolara, Williams, Emmanuel, Williams, Sofija, Pejkova, Zainab Al Balushi, Raza, Sayyed, Mustafa Abo Mohsen, Sadi, A Abukhalaf, Moises, Cukier, Hugo, Gomez-Fernandez, Sebastian Shu Yip, Ximena Paola Vasquez Ojeda, Marie Dione Sacdalan, Piotr, Major, José, Azevedo, Miguel, F Cunha, Ahmad, Zarour, Eduard-Alexandru, Bonci, Ionut, Negoi, Sergey, Efetov, Viktor, Kochetkov, Andrey, Litvin, Jc Allen Ingabire, Georges, Bucyibaruta, Ntirenganya, Faustin, Sosthene, Habumuremyi, Alphonsine, Imanishimwe, Haragirimana Jean de Dieu, Emmanuel, Munyaneza, Isaie, Ncogoza, Abdourahmane, Ndong, Dejan, Radenkovic, Min Hoe Chew, Frederick, Koh, James, Ngu, Arpád, Panyko, Uros, Bele, Jurij Aleš Košir, Hassan, Daoud, Ana Maria Minaya Bravo, Umesh, Jayarajah, Dakshitha, Wickramasinghe, Mohammed Elmujtba Adam Essa Adam, Martin, Rutegård, Malin, Sund, Michel, Adamina, Eleftherios, Gialamas, Karoline, Horisberger, Muhammad, Alshaar, Abel, Huang, Varut, Lohsiriwat, Shane, Charles, Haithem, Jlassi, Arda, Isik, Hervé Monka Lekuya, Slava, Kopetskyi, Hayder, Alsaadi, Sattar, Alshryda, Osaid, Alser, Brittany, Bankhead-Kendall, Kerry, Breen, Hassan, Mashbari, Fernando Bonilla Cal, Hamza, Al-Naggar, Mayaba, Maimbo, Dennis, Mazingi, Tom, Abbott, Melika, Akhbari, Ruth, Benson, Shivam, Bhanderi, Bruce, Biccard, Edward, Caruana, Sohini, Chakrabortee, Reema, Chapatwala, Ainhoa, Costas-Chavarri, Andreas, K Demetriades, Anant, Desai, Salomone Di Saverio, Thomas, Drake, John, Edwards, Jonathan, Evans, Marco, Fiore, Samuel, Ford, Christina, Fotopoulou, Alexander, Fowler, Kaori, Futaba, Ian, Ganly, Harelimana Grace James, Ewen, Griffiths, Alessandro, Gronchi, Peter, Hutchinson, Gabriella Yael Hyman, Joseph, Incorvia, Ritu, Jain, Michael, Jenkinson, Tabassum, Khan, Stephen Richard Knight, Angelos, Kolias, Søren, Kudsk-Iversen, Tsun Yu Kwan, Elaine, Leung, Julio, Mayol, Siobhan, Mckay, John, G Meara, Emily, Mills, Susan, Moug, Akshay, Patel, Roberto, Perinotti, Henry, E Rice, Keith, Roberts, Andrew, Schache, Richard, Shaw, Neil, Smart, Matthew, Stephens, Grant, D Stewart, Ella, Teasdale, Peter, Vaughan-Shaw, Raghavan, Vidya, Naomi, Wright, Natalie, Zimmelman, Ervis, Agastra, Dariel, Thereska, Sergio Martin Lucchini, Veronica, Laudani, Carina, Chwat, Ivana Ines Pedraza Salazar, Diana Alejandra Pantoja Pachajoa, Agustin, Duro, José Alfredo Calderón Arancibia, Giuliana, D'Aulerio, Nagendra, Dudi-Venkata, Natasha, Egoroff, Shebani, Farik, Natalie, Lott, Jana-Lee, Moss, Sarah, Rennie, Lorwai, Tan, Uyen Giao Vo, David, Watson, David, Watters, Tim, Bright, Paul, Hollington, Xuanyu, Zhou, Hidde, M Kroon, Anthony, Farfus, John, Barker, Eleanor, Watson, Sean, Stevens, Haider, Latif, Amanda Caroline Dawson, Alwin, Chuan, Vijayaragavan, Muralidharan, Enoch, Wong, Travis, Ackermann, Maurizio, Pacilli, Russell, Hodgson, Alexander, Heriot, Peter, Choong, Wendy, Brown, Surjit, Lidder, Justin, Yeung, Luke, Traeger, Guillermo, Regalo, Ralph, Gourlay, Sarit, Badiani, Cherry, Koh, Soni, Putnis, Fayza, Haider, Ashrarur Rahman Mitul, Niels, Komen, Bert, Dhondt, Serge, Cappeliez, Manon, Pigeolet, Martijn, Schoneveld, Jasper, Stijns, Wouter, Oosterlinck, Nicolas, Flamey, Cyrille, Kpangon, Mouhamed, Agbadebo, Sèmèvo Romaric Tobome, Aldo Vieira Barros, Samuel Aguiar Júnior, Heloisa Galvão do Amaral Campos, Jefferson, Gross, Felipe José Fernandez Coimbra, Luiz Paulo Kowalski, Fabiana, Makdissi, Suely, Nakagawa, Joao Pedreira Duprat Neto, Jose Guilherme Vartanian, Guilherme, Yazbek, Stenio, C Zequi, Ronald, Flumignan, Natalia, Jaworska, Angela, Dell, Harsha, Shanthanna, Abdollah, Behzadi, Carolyn, Nessim, Michelle, Mozel, Pascal, St-Germain, Crispin, Russell, Gary, Groot, Najib, Safieddine, Duminda, Wijeysundera, Antoine, Eskander, Sami, Chadi, Shawn, Mackenzie, Alana, Flexman, Fernando, Heredia, Julio, Villanueva, Sofia, Waissbluth, Roberto, Macchiavello, Mario, I Escudero, Tyare, Fuentes, Ximena, Mimica, Dinimo Bolivar Saenz, Lina, Caicedo, Juan Pablo Alzate, Joaquin, Luna, Nestor Fabian Pedraza Alonso, Camilo Ortiz Silva, Juliana, Rodriguez, Liliana, Silva-Igua, Martha Luz Torres, Lina María Trujillo, Albaro José Nieto Calvache, Julián, Balanta-Melo, Rafael, Figueroa-Casanova, Oscar-Julián, García-Montoya, Carlos Andres Marulanda Toro, Marcela Velez Botero, Maria Clara Mendoza Arango, Eneida Diaz Martinez, Valentina Gutiérrez Perdomo, Emileth, Montenegro, Julia, Rodriguez-Abreu, Dolores, Mejía, Galal, Abouelnagah, Sameh, Shehata, Ahmed Hossam Eldin Fouad Rida, Ramy, A Hassan, Mahmoud, M Saad, Mohamed Reda Loaloa, Badr, Mostafa, Mohamed, Qassem, Mohamed, Fahmy, Hesham, Abozied, Ahmed, Y Azzam, Sherief, Ghozy, Asser, Sallam, Ahmed, Shehta, Mohamed, Abdelkhalek, Rehab, Samaka, Amr, Morsy, Ahmed Elshawadfy Sherif, Abraham, Negussie, Tigist, Fisseha, Kibruyisfaw, Shumbash, Metasebia, Abebe, Seid Mohammed Yasin, Yemisirach Bizuneh Akililu, Abebe, Megersa, Teshome, Tefera, Melatework, Assefa, Bahru, Atnafu, Bereket, Tsegaye, Yoseph Solomon Bezabih, Silamlak, Sisay, Kebebe, Bekele, Moa, Jira, Habtamu, Derilo, Eyueal, 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Mohammed Shadrul Alam, Akm Khairul Basher, Shahnoor, Islam, M Nazmul Islam, S, Sabbir, Karim, Muntasir, Faisel, Sadia, Khan, Iftekhar Ibne Mannan, Nawshin, Nazia, Malissa, Bentham, Sasha, Corbin, Alex, Doyle, Asha, Eastmond, Amelia, Haynes, Margaret, O'Shea, Emil, Phillips, Keisha, Walkes, Evgeniy, L Artyushkov, Mark, L Kaplan, Vladislav, Straltsov, Yauheniya, Litvina, Alexei, Lyzikov, Victor, E Tihmanovich, Mafalda, Borges, Tim, Brits, Nicolas De Hous, Stefan De Wachter, Tomas, Menovsky, Xavier, Mortiers, Dorien, Vermeulen, Nils, Vleminckx, Dirk, Ysebaert, Julie, Bontinck, Danny, Bulthé, Ricky, Rasschaert, Anne-Sophie Van Haver, Koen Van Belle, Laurence, Verstraeten, Manon, Vounckx, Sébastien, D'Ulisse, Yasmine De Bruyne, Badih El Nakadi, Tessely, Heloise, Matteo, Luisetto, Sotirios, Marinakis, Maxime, Maton, Claire, Viste, Elke Van Daele, Mathieu, Vandeputte, Marc, Duinslaeger, Daniel, Jacobs-Tulleneers-Thevissen, Yanina, Jansen, Ward, Janssens, Rastislav, Kunda, Nouredin, Messaoudi, Michael, Ruyssers, Ellen Van Eetvelde, Marian, Vanhoeij, Jef Van den Eynde, Raf Van den Eynde, Ahmed, M Chaoui, Marcellin, Akpla, Souliath, Lawani, Hermann, Agossou, Hulrich Aouagbe Behanzin, Covalic, Bokossa, Hubert, Dewanon, Hugues, Yome, Alassan, Boukari, Oswald, Gbehade, Labissi Francois Amossou, Francis, Dossou, Tatjana, Barišić, Miran, Boras, Zdrinko, Brekalo, Ivana Čuljak Blagojević, Ana, Damjanović, Vedran, Dragisic, Ana Dugandžić Šimić, Filip, Gunaric, Martin, Kajic, Darko, Knežević, Tanja, Krešić, Valentina, Lasić, Ludvig, Letica, Vlatka, Martinovic, Iva, Mikulic, Josip, Miskovic, Hrvoje, Pehar, Pejana, Rastović, Irena, Sesar, Violeta, Šetka-Čuljak, Martina, Soljic, Dejan, Tiric, Vajdana, Tomić, Anja, Vasilj, Igor, Hudic, Renato Aguera Oliver, Felipe Azenha Lamonica, Jorge De Medeiros, Henrique Donizetti Bianchi Florindo, Rodolfo Jose Favaretto Filho, Fernanda Costa Pereira, Rodrigo, Rodrigues, Antonio Antunes Rodrigues Junior, Fernanda Ruiz de Andrade, Maisa, Salvetti, 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Juliana Sanchez, David Mauricio Solano Varela, Paula Torres Gomez, Marcial, Trillos, Ana María Vargas Patiño, Felipe, Vargas-Barato, Juan Pablo Villate Leon, María Alejandra Wagner Useche, Jesus, Acosta, Adriana, Almeciga, Luis Becerra Mendez, Rafael Jose Beltran, Ana, Bonilla, Miguel, Buitrago, Marino, Cabrera, Pedro Hernando Calderon Quiroz, Diego, Camacho-Nieto, Carlos Andrés Carvajal Fierro, Sergio Cervera Bonilla, Sandra, Diaz, Helena, Facundo, Jorge, Forero, Mauricio Garcia Mora, Karena Victoria Garcia Tirado, German Fabian Godoy Perez, Felipe, Gonzalez, Oscar, Guevara, Jairo Alonso Hernandez, David Ricardo Herrera Mora, Juan David Lalinde, Carlos, Lehmann, Eduardo Leon Llanos, Byron Eduardo Lopez De Mesa Lopez, Ivan, Mariño, Monica, Medina, Raúl Eduardo Pinilla Morales, Angela, Puerto, Andrea, Quintero-Ortíz, Juliana Rendón Hernández, Elio Fabio Sánchez Cortés, Alvaro Eduardo Sánchez Hernández, Raul, Suarez, Oscar, Suescun, Marco, Vanegas, Rodolfo, Varela, Jorge Luis Velez 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Alvarez, Cesar David Galindo Regino, Angela Maria Giraldo Velasquez, Carlos Enrique Melo Moreno, Jorman, H Tejada, Jesus Hernan Tovar, German Alirio Tovar, Edison Alexander Benavides Hernández, Claudia Milena Orozco-Chamorro, Gustavo Adolfo Angel, Christian Ali Buesaquillo, Victor David Olave Montaño, Andrés, Sánchez-Gómez, Daniela Patricia Escalante Ureche, Jairo Martinez Garrido, Eben-Ezer, Genda, Fabrice, Eboma, Kristina, Bitunjac, Karlo, Grulović, Marijana, Vučković, Goran, Šantak, Emanuel, Borovic, Ana Bosak Versic, Damir, Hasandić, Natasa Poldan Grabar, Suzana Srsen Medancic, Lucija, Brkic, Sara, Cokarić, Petra Pavic Palac, Zeljka, Samac, Josipa, Tomić, Marija, Vrdoljak, Ivan, Bacic, Bernarda, Bakmaz, Nikolina Bratošević Vučičić, Domagoj, Brzic, Samir, Canovic, Emilio, Dijan, Maja Grgec Dragicevic, Robert, Karlo, Suzana, Konjevoda, Petra, Kovačević, Ivan, Kovačić, Frane, Markulić, Luka, Matak, Domagoj, Morović, Gordan, Perišić, Andrea, Simic, Neven, Skitarelić, Matea, Veršić, 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Baelum, Mark Bremholm Ellebaek, Signe Bremholm Ellebaek, Anders, Hogh, Maria, Acosta, Yancy, Acosta, Pedro, Baez, Luis Alfredo Betances, Luis Rodolfo Bonilla, Daniel, Cabreja, Wilton Cabrera Cruz, María Mabel Collado Expósito, Aldo, Crespo, Octavio, Cruz-Pineda, Claudio Samuel D'óleo García, Pedro, Díaz, Remberto, Escoto, Jatnna, Figueroa, Luis, Garcia, U Garcia-Dubus Rodriguez, Humberto, Gomez, Adrian, Grullon, Fatherin, Guerrero, Lillian, Guzman, Thelma Rocío Jiménez Mosquea, Engels, Lazala, Ariela, Lopez, Leeany Maletta Francisco, Jhomayri, Mercado, Herisardy, Munoz, Jeffrey, Paulino, Maricely Ambar Perez Fernandez, Rudeily, Reyes, Lilia Rosa Reyes Guilamo, Ruben, Rivas, Claudia Alejandra Rivas Torres, Ada, Rodríguez, Madelin Tamar Rosario Villa, Eleazar, Santana, Joel, Soto, Nassin, Tactuk, Cristina Kristel Tonos Sardiñas, Raul, Ubinas, Jose, Victoria, Aaron, Villegas, Ricardo, Acra-Tolari, Larissa, Beltran, Luis Fernand Betances, Alejandro, Blaubach, Denisse Idalia Campos Mejía, Nathalia, Capellan, María Fernanda Cedeño Bruzual, Saray Cordero Spencer, Gabriella Cuevas Lantigua, Luis De Jesus, Gabriela, Díaz, Pedro Pablo Díaz Vásquez, Karla, Disla, Jesús Antonio Echavarría Uceta, Paola Irina Eusebio Jimenez, Damaris, Fernandez, Marlin Fernandez Camilo, Jiomar Manuel Figueroa Germosen, Maruel, Fortunato, Leyla Gabriel Fernández, Alicia German Dihmes, Héctor, Herrera, Elizabeth Leon Cuevas, Jose Alejandro Mata, Mirian Mateo De La Cruz, Dolores Mejia De la Cruz, Marcos, Mirambeaux, Fabio Ortiz De La Cruz, Henry, Paulino, Gabriela, Pelletier, Merycarla, Pichardo, Rodriguez Pumarol Próspero Enrique, Julio, Rivas, Ann Stephany Sanchez Marmolejos, Roman Santana Santana, Irina Suero Almanzar, María Magdalena Vásquez Sánchez, Nicolás, Campuzano, José Ricardo Negrete Ocampo, Maria, Armas, Alvaro Santiago LeMarie Guerra, Gustavo León Vizcaya, Omar Ahmed Abdelwahab, Ahmed, O Elmehrath, Mohammed Ezzat Mostafa, Gamal, Amira, Ibrahim, Sallam, Mohamed, Sherief, Ahmed, 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Maher, Hosain, Ahmed, Hossam, Hamza Hussein Aly Salama Aly, Mohamed, Ibrahim, Abdelrahman, Ibrahim, Nourhan, Ibrahim, Noha Mohamed Salah Ibrahim Moussa Hamouda, Monica, Iskander, Islam, Khalifa, Mostafa, Kotb, Nada, Mahmoud, Alaa Mahmoud Abo Shabana, Nora, Mamdouh, Maram, Metwalli, Khaled, Metwally, Mahmoud, Moghazy, Moustafa, Mohamed, Mohamed, Mourad, Esraa, Moustafa, Kamilia, Mubarek, Nour Eldin Nader, Ahmed, Nasser, Samaa, Omar, Mostafa Shehata Qatora, Mohamed, Ragab, Marawan, Ragal, Dina, Ramadan, Rana, Ramadan, Sara, Ramadan, John, Romany, Ahmed, Sabry, Yasmeen, Said, Sara, Salamah, Ahmed Mostafa Saleh, Mona Saleh Mesbah Mohamed Elkaffas, Alaa, Salem, Hashem, Salim, Ahmed, Samih, Ahmed Samir Abdelaal, Ahmed, Shaheen, Yassmeen Sharafeldin Mohammed, Abdelrahman, Shehata, Mohamed, Shemeis, Karim, Shenit, Mennatallah, Sheta, Asmaa, Soffar, Yousef, Tanas, Ahmed, Tarek, Nermin, Yehia, Omar Khaled Mohamed Eid, Ammar Yasser Abdulfattah, Ahmed, Elsaghir, Mohamed Fouad Elganainy, Omar Ibrahim Elsayed, Omar, Elmandouh, Omar, Hamam, Mostafa Ahmed Shehata, Areej, A Abdelaziz, Ahmed, M Abbas, Wael Abd El-Ghani, Hossam Aldein, S Abd Elazeem, Mustafa Abd Elsayed, Ahmed Yassien Abd-Elkariem, Shimaa, Abdalla, Mahmoud, Abdel-Aleem, Khaled, Abdelazeem, Mahmoud, Abdelfattah, Mohammed, Abdelhafez, Mohamed, M Abdelkarem, Ali, Abdelraouf, Lamess, Abdullaha, Hossam, Abubeih, Moaiad Eldin Ahmed, Nagm Eldin Abu Elnga Ahmed, Ahmed, Ahmed, Sarah Ahmed Saad, Sherif, Alaa, Ali, Alhussaini, Abdelrahman Ahmed Abdelrahman Ali, Ibrahim, Ali, Wagdi, Ali, Mohamed Ali Mohamed, Mohamed, Ashraf, Muhammad, Bassiouni, Mohamed, G El-Adawy, Mohammad, El-Sharkawi, Hussein, Elkhayat, Khaled, Elmaghraby, Shady, Elsdfy, Mohamed, Elsharkawy, Almoutaz, Eltayeb, Mohamed Esmat Mohamed, Esraa, Essam, Mahmoud, Fahd, Osama, Farouk, Rabea, Gadelkareem, Ahmed, Ghoneim, Mohammed Hamada Takrouney, Ahmed, Hamdan, Abd El-Rahman Hamed, Ahmad, Hasan, Mohamed Abdelghafor Hassanin, Islam, Hawal, Kerollos, Henes, Mohamed Omar Herdan, Helal, F Hetta, Omar, Ibrahem, Mostafa, Ibrahim, Islam, H Ibrahim, Mahmoud, Kamel, Mohamed, Khallaf, Shrouk, M Elghazaly, Abobakr, Mahfouz, Osman, Mahmoud, Wesam, Mahran, Doha, Mahrous, Abadeer, Marsis, Ayman, Mohamed, Aliae Mohamed Hussein, Amr Mohamed Sayed, Mahmoud, M Mohammed, Ahmed, Mokhtar, Fatma, A Monib, Ahmed, Nageeb, Mariam Albatoul Nageh, Mohammed, Nageh, Nehal Gamal Omar, Abdelrahman, Ragab, Abdelrahman, Ramadan, Abdallah Rashad Temerik, Aya, Sabry, Hadeer, Safwat, Omar, Salah, Ahmed Elhussiny Salah Mahmoud, Ahmed, Saleh, Mahmoud, Sallam, Ahmed, Samir, Reem, Sayad, Esraa, Sayed, Ahmed, S Sedik, Mohammed, Shahine, Antonios, Soliman, Wael, Soliman, Mohamed Gamal Taher, Randa, Wanees, Ebrahim Ahmed Yousof, Ahmed, Youssef, Omar Zein Elabedeen, Ahmed Emad Sayed Hassan, Shrouk Abdel Fattah, Ahmed, Abostate, Samar, Ali, Saad Ali Saad Salama, Mohamed, Allam, Ahmed, Alsadek, Ebrahim, Arafa, Ahmed, Barakat, Mohammed El Sherpiny, Gehad, Elbehairy, Mahmoud, Eleisawy, 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Krause, Frank, Meyer, Salmai, Turial, Bilal, Al-Nawas, Marco Johannes Battista, Jan, Goedeke, Annette, Hasenburg, Julia, Heider, Lena Katharina Mueller, Simon, Zeller, Sina Louisa Patrizia Jentschura, Karl-Friedrich, Kowalewski, Maximilian, Kriegmair, David, Männle, Christoph, Reissfelder, Nicole, Rotter, Claudia, Scherl, Steffen, Seyfried, Andreas, Kirschniak, Jens, Rolinger, Peter, Wilhelm, Franz, G Bader, Stephanie, Ottl, Alexandra Viktoria Behr, Alexandros, Diamantis, Andreas, Fichter, Florian, Grill, Matthias, Heck, Daniel, Jira, Michael, Kallmayer, Florestan, Koll, Stefan, Luhne, Bernhard, Meyer, Robert, Patachia, Ilaria, Pergolini, Seyer, Safi, Christoph, Schäffer, Moritz, Schirren, Helmut, Wegmann, Markus, Wirth, Zhaojun, Zhu, Ughur, Aghamaliyev, Mahmoud, Almaghrabi, Wolfgang, Böcker, Jan, Bruder, Konstantin, Frank, Viktoria, Herterich, Verena, Huber, Matthias, Ilmer, Christian, Kammerlander, Carl, Neuerburg, Viktor, H von Ehrlich-Treuenstätt, Jens, Werner, Nikolaus, Börner, 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Massimiliano, Gennaro, Lorenzo, Giannini, Marcello, Guaglio, Marco, Guzzo, Andrea, Leva, Alberto, Macchi, Elena, Manzo, Fabio, Martinelli, Ilaria, Mattavelli, Vincenzo Maria Mazzaferro, Francesco, Raspagliesi, Luigi, Rolli, Laura, Sala, Roberto, Salvioni, Mario, Santinami, Silvia, Segattini, Luca, Sorrentino, Carlotta, Zaborra, Alexandre, Anesi, Gianmaria Casoni Pattacini, Mattia Di Bartolomeo, Francesca, Pecchini, Arrigo, Pellacani, Micaela, Piccoli, Federico, Fusini, Andrea, Gattolin, Marco, Migliore, Roberto, Rimonda, Diego, Sasia, Elisabetta, Travaglio, Federica, Brunetti, Marco, Cereda, Marco, Ceresoli, Luca, Cigagna, Cristina, Dell'Oro, Alessandro, Fogliati, Robert, Fruscio, Tommaso, Grassi, Maini Marzia Isabella, Luca Carlo Nespoli, Massimo, Oldani, Sara, Ornaghi, Nicolò, Tamini, Carmine, Antropoli, Antonio, Castaldi, Alessio, Palumbo, Gaia, Altieri, Umberto, Bracale, Francesco, Corcione, Marcello De Luca, Giovanni Domenico De Palma, Maria Michela Di Nuzzo, Ruggero, Lionetti, 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Matteo, Filardo, Marika Sharmayne Milani, Franco, Ragni, Andrea de Manzoni Garberini, Edoardo, Baldini, Diana, Carpaneto, Michele, Cauteruccio, Corrado, Ciatti, Luigi, Conti, Serena, Gattoni, Pietro, Maniscalco, Gerardo, Palmieri, Calogero Puma Pagliarello, Giuseppe, Caristo, Raffaele, Galleano, Michele, Malerba, Marcello, Calabrò, Francesca, Farnesi, Elia Giuseppe Lunghi, Andrea, Muratore, Nicoletta Sveva Pipitone Federico, Joel Reuben Abel, Lorenzo, Andreani, Darienzo, Antonio, Vittorio, Aprile, Riccardo, Balestri, Giacomo, Benettini, Stefano, Berrettini, Luca, Bruschini, Massimo, Chiarugi, Federico, Coccolini, Simone, Colangeli, Camilla, Cremonini, Lodovica Cristofani Mencacci, Iacopo, Dallan, Silvia De Santi, Gregorio Di Franco, Lorena Di Girolami, Giacomo, Fiacchini, Niccolò, Furbetta, Stylianos, Korasidis, Marco, Lucchi, Andrea, Morandi, Luca, Morelli, Serena, Musetti, Carlo Maria Neri, Matteo, Palmeri, Miriana, Picariello, Francesco, Porcelli, Marco, Puccini, Nicolo, Roffi, Erica, Statuti, Dario, Tartaglia, Alberto, Tonelli, Matteo, Vianini, Gianluca, Baronio, Mauro, Montuori, Enrico, Pinotti, Stefano Maria Massimiliano Basso, Federica, Maffeis, Paolo, Ubiali, Lorenzo, Aguzzoli, Saverio, Coiro, Giuseppe, Falco, Vincenzo Dario Mandato, Valentina, Mastrofilippo, Simone, Mele, Caterina, Baldi, Carlo, Corbellini, Gianluca Matteo Sampietro, Massimo, Dugo, Mauro, Garino, Chiara, Marafante, Antonio, Masciandaro, Elisabetta, Moggia, Alessandra, Murgese, Felice Eugenio Agro, Gabriella Teresa Capolupo, Filippo, Carannante, Marco, Caricato, Vincenzo, Denaro, Erica, Mazzotta, Rocco, Papalia, Giuseppe, Pascarella, Alessandro, Strumia, Biagio, Zampogna, Matteo, Cinquepalmi, Marco, Colasanti, Celeste Del Basso, Federica, Falaschi, Nicola, Guglielmo, Roberto Luca Meniconi, Alessandra, Pecoraro, Sofia, Usai, Giacomo, Crescentini, Antonella, Larcinese, Emanuele, Picone, Giovanni, Sinibaldi, Annamaria, Agnes, Salvatore, Agnes, Sergio, Alfieri, Francesco, Belia, Valentina, Bianchi, Giuseppe, Bianco, Alberto, Biondi, Paola, Campennì, Valerio, Cozza, Sabatino, D'Archi, Domenico, D'Ugo, Veronica De Simone, Marta Di Grezia, Sofia Di Lorenzo, Federica, Ferracci, Valeria, Fico, Gianluca, Franceschini, Pietro, Fransvea, Giulio, Gasparini, Luca, Gordini, Antonio La Greca, Francesco, Litta, Celestino Pio Lombardi, Angelo Alessandro Marra, Angelo, Parello, Marco Maria Pascale, Romeo, Patini, Gilda, Pepe, Roberto, Persiani, Caterina, Puccioni, Carlo, Ratto, Fausto, Rosa, Gianmarco, Saponaro, Lorenzo, Scardina, Tedesco, Silvia, Giuseppe, Tropeano, Maria, Benevolo, Daniele, Bugada, Flaminia, Campo, Maria Gabriella Dona, Valentina, Manciocco, Paolo, Marchesi, Riccardo, Mastroianni, Francesco, Mazzola, Silvia, Moretto, Raul, Pellini, Gerardo, Petruzzi, Barbara, Pichi, Giuseppe, Simone, Gabriele, Tuderti, Jacopo, Zocchi, Luigi Marino Cosentino, Andrea, Sagnotta, Roberta, Angelico, Vittoria, Bellato, Michela, Campanelli, Marzia, Franceschilli, Michele, Grande, Giorgio, Lisi, Tommaso Maria Manzia, Lorenzo, Petagna, Bruno, Sensi, Giuseppe, Sica, Leandro, Siragusa, Giuseppe, Tisone, Marco, Assenza, Barbara, Binda, Massimo, Biondi, Gioia, Brachini, Placido, Bruzzaniti, Mauro, Casagrande, Flavia, Ciccarone, Pierfranco Maria Cicerchia, Bruno, Cirillo, Daniele, Crocetti, Giancarlo, D'Ambrosio, Vito, D'Andrea, Francesca De Felice, Giorgio De Toma, Carlo Della Rocca, Giulia, Duranti, Pietro, Familiari, Enrico, Fiori, Giovanni Battista Fonsi, Alessandro, Frati, Stefania La Rocca, Filippo La Torre, Pierfrancesco, Lapolla, Giovanni, Marruzzo, Simona, Meneghini, Andrea, Mingoli, Andrea, Picchetto, Antonella, Polimeni, Diego, Ribuffo, Maurizio, Salvati, Antonio, Santoro, Paolo, Sapienza, Luigi, Simonelli, Valentino, Valentini, Martina, Zambon, Giuseppa, Zancana, Emma, Zuppi, Simone, D'Annunzio, Cosimo De Nunzio, Silvia, Fiorelli, Mohsen, Ibrahim, Chiara, Loffredo, Domenico, Massullo, Cecilia, Menna, Rocco, Monica, Massimiliano, Pelli, Erino Angelo Rendina, Leonardo, Teodonio, Andrea, Tubaro, Giulio, Argenio, Giulio, Accarino, Accarino, Giancarlo, Antonio Nicola Giordano, Luca, Cardinali, Elisa, Sebastiani, Grazia, Travaglini, Erika, Andreatta, Emanuele Luigi Giuseppe Asti, Daniele, Bernardi, Luigi, Bonavina, Caterina, Froiio, Andrea, Lovece, Chiara, Copelli, Alfonso, Manfuso, Pasquale Di Maio, Marco, Giudice, Oreste, Iocca, Rosario, Cennamo, Tommaso, Cornali, Francesco Di Marzo, Cristian, Altana, Francesco, Bussu, Giampiero, Capobianco, Anna Giacomina Carta, Sandro, Ciccarello, Maria Laura Cossu, Pietrina, Cottu, Giacomo De Riu, Salvatore, Dessole, Francesco, Dessole, Salvatora, Dettori, Carlo, Doria, Alessandro, Fancellu, Claudio, F Feo, Giorgio Carlo Ginesu, Giuliana, Giuliani, Marco Giuseppe Iannuccelli, Massimo, Madonia, Roberto, Mancino, Olindo, Massarelli, Gianfranco, Meloni, Fabio, Milia, Andrea, Mulliri, Teresa, Perra, Marco, Petrillo, Antonio, Piras, Franco, Piredda, Francesco, Pisanu, Alberto, Porcu, Davide, Rizzo, Angelino, Sanna, Antonio Mario Scanu, Fabrizio, Scognamillo, Damiano, Soma, Anna Rita Tanca, Alessandro, Tedde, Matteo, Tedde, Luigi Angelo Vaira, Andrea Bartalini Cinughi de Pazzi, Osvaldo Carpineto Samorani, Daniele, Fusario, Luigi, Marano, Gaia, Oldrà, Anna Lisa Pesce, Stefania Angela Piccioni, Luca, Resca, Vincenzo, Ricchiuti, Franco, Roviello, Vinno, Savelli, Alberto, Abrate, Pierpaolo, Bordoni, Lorenzo, Bosio, Guglielmo, Clarizia, Francesco, Fleres, Marco, Franzini, Antonio, Fratto, Pierluigi, Giumelli, Alessandro, Grechi, Alessandro, Longhini, Fabrizio, Lorusso, Elisa, Scarnecchia, Federica, Scolari, Alessandro, Spolini, Vincenzo, Maiuri, Matteo, Papandrea, Arturo, Roncone, Lorenzo, Conti, Andrea, Rizzi, Marco, Rovagnati, Alberto, Brolese, Tommaso, Cai, Francesco Antonio Ciarleglio, Francesca, Dalprà, Gianni, Malossini, Liliana, Mereu, Irene, Tamanini, Saverio, Tateo, Giovanni, Viel, Enrico, Battistella, Paolo Boscolo Rizzo, Cristoforo, Fabbris, Marco, Massani, Giacomo, Spinato, Roberta, Tutino, Ugo, Grossi, Alessandro, Iacomino, Simone, Novello, Maurizio, Romano, Serena, Rossi, Giulio, Santoro, Giacomo, Zanus, Sokol, Trungu, Giada, Aizza, Gabriele, Bellio, Selene, Bogoni, Marina, Bortul, Biagio, Casagranda, Sara, Cortinovis, Nicolò de Manzini, Davide, Drigo, Paola, Germani, Manuela, Mastronardi, Lucia, Paiano, Silvia, Palmisano, Pier Luigi Filosso, Francesco, Guerrera, Matteo, Marro, Mauro, Rinaldi, Enrico, Ruffini, Stefano, Salizzoni, Laura, Bardelli, Mattia, Berselli, Giacomo, Borroni, Eugenio, Cocozza, Matteo, Desio, Bottazzoli, Elisa, Giuseppe, Ietto, Valentina, Iori, Domenico, Iovino, Lorenzo, Livraghi, Valentina, Marchionini, Stefano, Megna, Emma Amal Nahal, Mara, Palumbo, Valeria, Quintodei, Alessandra, Zullo, Lucrezia, D'Alimonte, Giovanni, Pirozzolo, Chiara, Vignotto, Tommaso, Campagnaro, Andrea, Caravati, Simone, Conci, Carlotta De Cristofaro, Gabriele, Gecchele, Tommaso, Giuliani, Jacopo, Graziosi, Alfredo, Guglielmi, Salvatore, Paiella, Corrado, Pedrazzani, Tommaso, Pollini, Simone, Rattizzato, Andrea, Ruzzenente, Roberto, Salvia, Giulia, Turri, Matilde, Bacchion, Giovanni, Butturini, Andrea, Casaril, Alessandro, Giardino, Harmony, Impellizzeri, Marco, Inama, Frigerio, Isabella, Gianluigi, Moretto, Marco De Zuanni, Enrica, Deiana, Mario, Guglielmo, Alessandro, Broglia, Claudia, Casarini, Caterina Costanza Zingaretti, Marta, Bonaldi, Giovanni, Cesana, Francesco, Mastriale, Stefano, Olmi, Matteo Uccelli Yasuyuki Fukami, Takuya, Saito, Tsuyoshi, Sano, Naoki, Hirai, Kazuyoshi, Hirota, Tetsuya, Kushikata, Tasuku, Oyama, Junichi, Saito, Katsuhiko, Ishibashi, Mizue, Kamiyama, Kyongsuk, Son, Kentaroh, Tarao, Takayuki, Yamada, Toshiya, Shiga, Chisaki, Aze, Yoshihiko, Deguchi, Hirotoshi, Hasegawa, Tatsuki, Hoshino, Yasushi, Innami, Hiroyuki, Inoue, Shingo, Ito, Takeshi, Nomura, Tomomi, Ogihara, Reina, Okada, Takashi, Ouchi, Yuri, Sekiya, Keikoku, Tachibana, Emi, Takano, Masae, Yamamoto, Shuko, Matsuda, Yuka, Matsuki, Kenji, Shigemi, Teruyuki, Hiraki, Yui, Inoue, Shosaburo, Jotaki, Tatsuro, Abe, Masatoshi, Eto, Junichi, Inokuchi, Eiji, Kashiwagi, Fumio, Kinoshita, Satoshi, Kobayashi, Ken, Lee, Takashi, Matsumoto, Keisuke, Monji, Hidekazu, Naganuma, Masaki, Shiota, Ario, Takeuchi, Shinju, Obara, Saori, Takatsuki, Saori, Tanaka, Koji, Iida, Kota, Kagawa, Shuichiro, Neshige, Tomohiro, Chaki, Naoyuki, Hirata, Satoshi, Kazuma, Motonobu, Kimizuka, Sho, Kumita, Noriaki, Nishihara, Sato, Satoshi, Atsushi, Sawada, Shunsuke, Tachibana, Michiaki, Yamakage, Yuta, Nakamura, Kozo, Sato, Tomoya, Irie, Tomoko, Irisawa, Eiki, Kanemaru, Yuko, Koga, Yoshihiko, Chiba, Jun, Makino, Shinnosuke, Ohama, Shinichiro, Okada, Kano, Teruaki, Tatsuya, Kida, Tomohide, Takei, Kazuhiro, Hanazaki, Hiroyuki, Kitagawa, Tsutomu, Namikawa, Toshiyuki, Mizota, Chikashi, Takeda, Shintaro, Yagi, Hiroshi, Imai, Makoto, Ishitobi, Manabu, Kato, Kouhei, Nishikawa, Takeshi, Sasaki, Hiroshi, Yonekura, Akihiro, Kanaya, Daisuke, Irimada, Haruka, Ishikawa, Kaiho, 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Mubaydeen, Husam, Sarayrah, Mohammad Abdel Elah, A Tarawneh, Mohammad Yousef Karasneh, Amany, Zurgan, Mohammad, Alassaf, Sayel, H Alzraikat, Justin, Z Amarin, Ahmed, Hijjawi, Haya, H Suradi, Louay, Y Zaghlol, Ahmad, Abdalah, Ghaida, Abdallah, Ammar Abu Tarieh, Tareq, Abu-Libdeh, Faisal, Abualteen, Murad Al Abdallah, Zakaria Al Bdour, Seif Al Dahabrh, Farah, Al-Kasaji, Zaid Al-Sheikh Ali, Mohammad, Al-Thaher, Tareq, Alnajjar, Mohannad, Alqedrh, Mohammad, Alsaleh, Mohammad, Alzaatreh, Ghandi, Amayreh, Yazeed, Ayasra, Ahmad, Eid, Ibrahim, Ghayada, Khaled Moh'd Ahmed Hasanein, Anas, Hassouneh, Raid, Hijazeen, Majedah, Hmeidan, Ahmed, Khaled, Barihan, Khasawneh, Omar, Kifayeh, Yasser, Lafi, Jasem, Seba, Qusai, Semrin, Fda, Sma, Mohammad, Theab, Haitham, Tumeh, Muna Aba Zaid, Alaa, Abazeed, Bader, Abbad, Osaid, Abbadi, Nizar, Abu-Ishkerih, Malk, Al-Osta, Reham, Al-Zyadat, Bashar Omar Falah Alawneh, Majd, Alhattab, Mohd Mujahed Alkurdieh, Ziad, Awwad, Mohammad, Hammouri, Hamzeh, Hussein, 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Alameen, Rehab, Alarabi, Alarabi, Alarabi, Aisha, Alelwany, Abdulkarim, Alesmail, Noran, Algadi, Khuloud, Almaqrahi, Hadel, Alosta, Mohamed, Alsharedi, Rasha, Bashir, Mahmoud Ben Ghrema, Sari Bin Nour, Sofian, Elbarouni, Ahmed, Elhadi, Abdulmohimen, A Elkhadar, Esraa, Elkouba, Nabiha, Elmsherghi, Abdulmohimen, Gammoudi, Abdulraouf, Ghariba, Fatima Zayed Gjam, Arwa, Haidar, Hala, Helal, Mohammed, Huwaysh, Ahmed Khalid Alhadheeri, Eslam, Kriem, Halim, Osman, Mohamed Ali Ossman, Marwah, Shilfeet, Laila, Turshani, Nouran, Albishty, Abdulmueti, Alhadi, Salem, Ali, Manal Ahmed Altoumi, Sumayyah Ghayth Bahroun, Eman, Younes, Hana, Atarabulsi, Mohamed, Elshaibi, Abdullmujeeb, Othman, Hayat Ben Hasan, Najat Shaban Ben Hasan, Rabab Shaban Ben Hasan, Vidmantas, Barauskas, Edvinas, Dainius, Zilvinas, Dambrauskas, Albertas, Dauksa, Inga, Dekeryte, Rita, Gudaityte, Kristijonas, Jasaitis, Akvilė, Koženiauskaitė, Virgilijus, Krasauskas, Ausra, Lukosiute-Urboniene, Almantas, Maleckas, Romualdas, 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Rakotoarisoa, Maharo, Ramifehiarivo, Solonirina Harinarindra Ranaivoson, Hajamihamina Marina Parfaite Randriantsoa, Narindra Njarasoa Mihaja Razafimanjato, Jeannie Ba Razafindrahita, Solofoarimanana, Solofoarimanana, Guillaume Odilon Tsiambanizafy, Rakotonaivo Mamisoa Judicaël, Corinne Eulalie Solo, Tojomamy Herinjaka Ralaizafindraibe, Fanonjomahasoa Safiry Andofenohasina, Hanta, Rasataharifetra, Vanona Barijaona Razafindraibe, Angelin Sablon Herinirina, Andre, Das, Thanga, Ganapathy, Yohesuwary, Gunarasa, Kalyani, Mariapan, Maathichsudhaar, Muniandy, Mohd Firdauss Osman, Mohd Azem Fathi Mohammad Azmi, Jien Yen Soh, Wan Zainira Wan Zain, Andee Dzulkarnaen Zakaria, Zaidi, Zakaria, Kheng Hooi Chan, Firdaus, Hayati, Syamim, Johan, Jin Jiun Mah, Ratha Krishnan Sriram, Sentilnathan, Subramaniam, Nur Shahirah Binti Muhammad Shahimi, Khairul Hazim Hamdan, Mohd Razali Ibrahim, Guhan, Muthkumaran, Ju Ann Tan, Mohana Raj Thanapal, Dayang Anita Abdul Aziz, Mae-Lynn, Bastion, Mohd Hairul Nizam 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Sainal, Mat Salleh Sarif, Richelle, Chua, Aini Fahriza Ibrahim, Abdul Rauf Bin Ahmad, Yii Ling Lau, Ka Yee Liew, Kandasami, Palayan, Hui Yu Wong, Jasiah, Zakaria, Nor Azimah Abd Aziz, Norazila Abdul Rahim, Noorneza Abdul Rahman, Bahiyah, Abdullah, Mohamed Faizal Bin Sikkandar, Fatin, Firman, Nik Mohd Hazleigh, Intan Kartika Kamarudin, Shahril, Khalid, Mohd Fairudz Mohd Miswan, Akmal Zulayla Mohd Zahid, Norasyikin, Mustafa, Kadhim, Obaid, Mohd Yusoff Bin Yahaya Yahaya, Ahmad Ramzi Yusoff, Predrag, Andrejevic, Jeremy Borg Myatt, Svetlana, Brincat, Clifford, Caruana, Kurt Lee Chircop, Francesca, Chircop, Daniel Mario Chircop, Charles, Cini, Viktoria, Czok, Melanie, Farrugia, Gabriella, Grima, Fatimah Mj Hassan Almukhariq, Esther, Muscat, Darryl, Pisani, Mohsin Hassan Khan Roshan, Nicholas, Schembri, Mohamed, Shoukry, Neville, Spiteri, Gilbert, Tanti, Ziad Aboharp Hasan, Alberto Bazan Soto, Cedillo Rodrìguez Jonathan Rubén, Gustavo Esteban Lugo Zamudio, David Gerardo Miranda Gómez, José 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Uros, Bumbasirevic, Zoran, Dzamic, Boris, Kajmaković, Bogomir, Milojevic, Nebojša, Prijović, Marko, Zivkovic, Aleksandar, Lazic, Nebojsa, Mitrovic, Dejan, Stevanovic, Marko, Buta, Ana, Cvetkovic, Igor, Djurisic, Merima, Goran, Zorka, Inic, Andjela, Ivezić, Nikola, Jeftic, Marko, Jevric, Vladimir, Jokic, Milan, Kocic, Zoran, Kozomara, Ivan, Markovic, Srdjan, Nikolic, Nada, Santrac, Nevena, Savković, Igor, Spurnic, Dobrica, Stevic, Dejan, Stojiljkovic, Jovana, Tripkovic, Nikola, Vucic, Milan, Zegarac, Tatjana, Dejanovic, Vladimir, Djukic, Srdjan, Marinković, Miljan, Milanovic, Nemanja, Pijanovic, Milena, Radosavljevic, Predrag, Savic, Dejan, Stojakov, Rastko, Živić, Sinisa, Ducic, Mikan, Lazovic, Jovana, Bojičić, Vladica, Cuk, Jovan, Juloski, Aleksandar, Karamarkovic, Marko, Kenic, Bojan, Kovacevic, Igor, Krdzic, Vladan, Milutinović, Vladimir, Djan, Velicko, Trajkovic, Dragana, Zivkovic, Aleksandar, Đermanović, Danica, Golijanin, Dejan, Lukic, Zoran, Radovanovic, Dragana, Radovanovic, Sanja, Zahorjanski, Adrian, Chiow, Jun Xian Hing, Lip Seng Lee, Sey Kiat Terence Lim, Chi Wei Mok, Su-Ming, Tan, Hiang Jin Tan, Hana, Arbab, Candy, Choo, Doris Mae Dimatatac, Yee, Low, Hui Wen Chua, Tousif, Kabir, Sabrina, Ngaserin, Lester, Ong, Kiat Tee Benita Tan, Alvin, Tan, Wei-Wen, Ang, Yew-Lam, Chong, Jeffrey, J Leow, Biquan, Liu, Ming Ngan Aloysius Tan, Ern Yu Tan, Kar Yong Wong, Sharon, Yeo, Ladislav, Czako, Branislav, Gális, Kristián, Šimko, Radoslav, Morochovič, Martin, Paulo, Marián, Sedlák, Jan, Grosek, Ales, Tomazic, Leyla Al Mahdawi, Nuhi, Arslani, Andrej, Avsenak, Andrej, Bergauer, Krešimir, Blažević, Dejan, Bratus, Dalibor, Cankoski, Andrej, Cokan, Bojana, Crnobrnja, Andraz, Dovnik, Vojko, Flis, Samo, Fokter, Urska, Gajsek, Minja, Gregorič, Marko, Hazabent, Tomaz, Jagric, Niko, Kavčič, Jure, Knez, Nina, Kobilica, Rok, Kovačič, Lara, Lukman, Urska, Marolt, Jan, Mlakar, Tamara, Mohorko, Andrej, Moličnik, Ivan, Perić, Stojan, Potrč, Milena Senica Verbic, Mateja, Sirše, Jerneja, Vidmar, Adnan Sayid Abdo, Abdifatah Dahir Ali, Abdilaahi Ahmed Hayir, Sadiq, Ibrahim, Afnan, Nuh, Kadra, Omar, Ridwan, Saeed, Nikita, Blake, Cassandra, Ferreira, Corne, Nel, Colin, Noel, Marcel de Kock, Nathan, Kaplan, Emile, Kayombo, Paballo Clinton Khaeane, Asha, Malan, Wikus Wessel Mulder, Daylen, Rutledge, Cornel, Steyn, Gert, Steyn, Naser, Almgla, Mohamed, Daoub, Hammaad, Gamieldien, Thomas, Hilton, Nazmie, Kariem, Maahir, Kariem, Christo, Kloppers, Maritz, Laubscher, Wanga, Mtimkulu, Walid, Mugla, Daniel, Nel, Ferhana, Gool, Timothy, Hardcastle, Wasim, Mahomed, Nivashen, Pillay, Kayla, Rossini, Stephanie Van Straten, Annamart, Laubscher, Adelaide, Lee, Mohammed Yusuf Parker, Sinead, Quirke, Therese Du Preez, Adeline, Jacobs, Reinier, Swart, Modise Zacharia Koto, Neha, Kumar, Imraan, Sardiwalla, Mapuor, Areu, Juan Campos Garcia, Paula, Ferrara, Christoph José Klein Zampaña, Raquel, Lopez, Hernan, Sandoval, Guillermo, Carreño, German Mínguez Ruiz, Conrado Andrés Ros, Raquel Angulo Artal, Luis, Barbier, Guillermo, García-Operé, Marta, Jiménez-Jiménez, Héctor, Marín, Mikel, Oñate, Luis Antonio Pascua-Gómez, María Alexandra Pesántez Peralta, Ibabe Villalabeitia Ateca, Ladislao Cayetano Paniagua, Joan, Camí, Pablo, Collera, Martínez, David, Carlos Javier Gómez Díaz, Jordi Querolt Coll, M Dolors Rosines Cubells, Cristina Soto Montesinos, Guillermo, Triana, Marina, Xicola, Alfonso, Alias, Albert, Baduell, Mariano, Balaguer-Castro, María Pilar Camacho Carrasco, Marina Cámara Vallejo, Borja Campuzano Bitterling, Guillem, Claret, Francisco, J Cuesta-González, Alberto Di Somma, Joaquim Enseñat Nora, Neus, Fabregas, Ada Ferrer Fuertes, Abel, Ferrés, Cesar, Ginesta, Jose Juan Gonzalez Sanchez, Isabel, Gracia, Jhon Alexander Hoyos Castro, Montsant, Jornet-Gibert, Xavier, Morales, Alejandra, Mosteiro-Cadaval, Leire, Pedrosa, José Poblete Carrizo, Marina, Renau-Cerrillo, Luis Alberto Reyes Figueroa, Pedro Roldan Ramos, Jordi Rumià Arboix, Marta, Sabater-Martos, Josep, M Segur, Thomaz, E Topczewski, Jorge, Torales, Ramon, Torné, Pere, Torner, Ricard, Valero, Marian, Vives-Barquiel, Eulalia, Ballester, Alberto Basterra Rincon, Vitiello, Giulia, Belén Martin Arnau, Marta, Gil, Silvia, Martin, Monica, Serrano-Navidad, Mauricio Agüero Mariño, Núria Casanova Torrequebrada, Berta Fabregó Capdevila, Adrián López Campillo, Gemma, Mancebo, Ester, Miralpeix, Blanca, Montcusí, Marina, Munarriz, Ariadna, Salvadó, Josep, M Sole-Sedeno, Clara Téllez Marquès, Ana Centeno Álvarez, Ruth Lopez Gonzalez, Luisana Riba Combatti, Andrea Sanz Llorente, Miguel Bejarano Serrano, Blanca Capdevila Vilaró, Maria Coronas Soucheiron, Mario Cuesta Argos, Irene de Haro Jorge, Yaiza Galvañ Félix, Luis, García-Aparicio, Rebeca, Leal, Albert Malet Contreras, Irene, Martínez-Padilla, Clara, Massaguer, Ines Moraleda Gudayol, María Elena Muñoz Fernández, Paco, Parri, Cristina Pérez Costoya, Javier, Rojas-Ticona, Leopoldo Tapia Moral, Francisco, Vicario, Francesc Angles Crespo, David Bosch Garcia, Berta, Escudero, Carlos Garcia Cardona, Sergi, Bellmunt-Montoya, Javier de la Torre, Úrsula, Acosta, Iago Alvarez Saez, Eva Andreu Riobello, Fernando Ascanio Gosling, Jose, Bagan, Irene, Brana, Bartomeu, Caimari, Marta Cicuendez López Ocaña, Anna, Conesa, Alba de Pablo García-Cuenca, Natalija, Dediulia, Francesc, Duran-Valles, Jordi Giralt López de Sagredo, Maria Jose Gomez-Jurado, Ernesto, Guerra-Farfan, Juan Sebastian Guillén, María Guisasola Rabés, Viviana Andrea Hernández Angel, Maria Jurado Ruiz, Yuri, Loaiza, Manuel, Lopez, Susana, Manrique, Maria Dolores Mateo Arzo, Joan, Minguell-Monyart, Enric Miret Alomar, Sonia Monreal Clua, Víctor Morales Ariza, Clara Morales Comas, Judith, Murillo, Jose Maria Nieto Rodriguez, Elena Vilardell Ortiz, Jorge, Pamias, Montserrat Pascual Pascual Arellano, Remei Perera Sarri, Aleix Pons Bartroli, Nil, Prat, Alfredo Pueyo Ferrer, Rosa Pujol Pina, Jordi, Raurich-Leandro, Maria José Reche Padilla, Joaquín Rivero Déniz, Natalia, Rodriguez, Manuel Saez Barba, Vanessa Sanchez Torrents, Berta, Serrano, María Sol Siliato Robles, Christian Siso Raber, Iñigo, Soler, Maria Carmen Suescun López, Jordi Teixidor Serra, Cristina, Tello-Díaz, Marta Utrilla Pérez, Ramon, Vilallonga, Irene Vives Roselló, Vázquez García César, Mireia, Gili-Bueno, Carlos Gomez Roig, Gloria, González, Aamer, Malik, Maria Del Mar Martí-Ejarque, Mario Rafael Medina Hernández, Carolina, Pozo, Laura, Ruiz-Villa, Nuria, Sierra, Antonio, Valle, Susana, Velasquez, Mirentxu, Arrieta, Daniel, Escobar, Arkaitz, Lara, Alicia, Rojo, Idoia, Villamor, Javier Aitor Zabala Lopez-Maturana, Begoña, Estraviz, Laura Fernández Gómez Cruzado, Melania González de Miguel, David, Lecumberri, Victor Luis Gomez Corujo, Silvia, Bleda, Joaquin De Haro, Carlos, Martínez-Pinedo, David, Padilla-Valverde, Rafael Picón Rodríguez, Francisco Javier Redondo Calvo, Daniel, Sanchez-Pelaez, Alfonso Espinosa Ruiz, Eduardo, Rodriguez, Ignacio Alcalá Rueda, Gonzalo Díaz Tapia, Alvaro Sanchez Barrueco, Maria Dieguez López, Isabel López García, Pilar López-Toribio López, Marina, Bosch, Carolina Curtis Martínez, Alba Fernández Candela, Sandra Lario Pérez, Cristina Lillo García, Clara López de Lerma Martínez de Carneros, Francisco López Rodríguez-Arias, Inmaculada, Oller, Saray, Quinto, Luis, Sánchez-Guillén, Antonio Sanchís López, Álvaro, Soler-Silva, Daniel Triguero Cánovas, Victoria Garcia Peces, Estefania, Hernández-García, Guillermo, Plaza, Rafael Abad Alonso, Francisca Aranda Lozano, Marta Calvo Fernández, Eneko Del Pozo Andres, Josune Etxabe Gurrutxaga, Francisco Javier Fernández Pablos, Francisco Javier Ibáñez-Aguirre, Begoña Ochoa Villalabeitia, Natalia, Ortega, Amaia Sanz Larrainzar, Irune Vicente Rodriguez, Javier Jimenez Miramón, Jose, M Jover, Tamara, Llamero, Jose Luis Ramos Rodriguez, Ainhoa Valle Rubio, Maria Teresa Albiol, Codina, Antonio, Clara, Codony, Ramon Farres Coll, Cristina Farrés Pla, Nuria Gomez Romeu, Santiago, Lopez-Ben, Marcel, Pujadas, Berta, Tió, Francesc, Tuca, Elizabeth, Bárcena, Esther Brea Gómez, Antonio Francisco Guisado Calderón, Elisabeth Fernandez Castro, Montserrat Mairal Fraile, Oscar, Pastor, Cristina García Amador, Raquel Latorre Fragua, Marta, Allue, Pablo, Colsa, Teresa Gimenez Maurel, Raúl Latorre Tomey, Luis Francisco Martín Anoro, Luca, Ponchietti, Alejandra Utrilla Fornals, Carlo, Brugiotti, Carlos Jiménez Viñas, Fátima, Sena-Ruiz, Julio, Plata-Bello, Octavio, Arencibia, Daniel Gonzalez Garcia-Cano, Maria, Laseca, Antonio, Navarro-Sánchez, David Ortiz López, Maria, Pelloni, Sara, Berrocal, Elima Pilar Cagigal Ortega, Jorge, Calvera, Iria, Cervera, Patricia Díaz Peña, Silvia Verónica Domínguez Ovejas, Francisco, Donis, Patricia Fernández Bernabé, Gema, Fraga, Raúl Garcés García, Antonio, García, Elena Garcia De Castro, Antonio García Domínguez, Miguel Angel García García, Judit, Gonzalez, Carles Heredia Llinàs, Inés, Hernández, Norberto Herrera Merino, Carmen Lucero León Gámez, Ana Luis Siles, Maria Marqueta De Salas, Paula Martinez Pascual, Almudena Ortiz Simón, Laura, Osuna, Marta Perez Gonzalez, Antonio Ramos Bonilla, Lorena Rodríguez Gómez, Jose Luis Uquillas, Miguel Angel Alonso Prieto, Marta, Ballesteros-Pomar, Sara Busto Suarez, Mario, Castaño, Laura Castillo Pardo, Mario De Arriba Alonso, Fernando Diez Burón, Anna Farrés Rabanal, Diego Fernández-Samos Fernández, David, Garcia, Cristina García Pérez, Miguel García Sanz, Cesar, Gracia, Javier, Gualis, Gonzalo Gutiérrez Carrillo, Mateo, Hevia, Eva Higuera Miguélez, Gregorio, Laguna, Cristina Lombardia Gonzalez de Lera, Pablo López Martínez, Pasquale, Maiorano, Sergio Marcos Contreras, Elio Martín Gutiérrez, Marta, Molina, Irene, Perez, Teresa Renedo Villar, Luis Angel Suarez Gonzalez, Eva Alvarez Torres, Luz Bueno Rey, Zulay Adriana Calderon Barajas, Ana, M Castaño-Leon, Aida, Fernández, Pablo Garcia Pimentel, Luis, Jimenez-Roldan, Meta, Levstek, Rosalia Navarro Casado, Claudia Olea Vielba, Ana Maria Parada Rodriguez, Igor, Paredes, Patricia, Pascual-Cambero, Miguel Saiz Sánchez-Buitrago, Claudia Sarrais Polo, Victor Zarza Fernandez de Alegria, Mireya, Bonet, Alberto Encinas Vicente, Jose Miguel Villacampa Auba, Maria Dolores Burgueño, Patricia Serrano Méndez, Thomas, W Jorgensen, Mercedes, Martin, Mónica, Huecas, Felipe, Velasco, Verónica Alen Villamayor, Santiago Alonso Bartolomé, Miguel Alonso Juarranz, Luis Felipe Ávila-Ramírez, Javier Buendia Pérez, Barbara, Burgos-Blasco, Enrique Camarero Rodríguez, Paula Campelos Fernández, Claudia, Celotti, Marco Ciappara Paniagua, Ignacio, Cristobal, Alejandro Encinas Bascones, Elena, Fernandez-Martin, Inés Gil Prados, Jesus Gimeno Hernandez, Maria Alejandra Giraldo, Manuel Gomez Cervantes, Noemi Guemes Villahoz, Araceli Hernández Ramos, Maria Cruz Iglesias Moreno, Bibiana Lasses Martínez, Francisco Leyva Rodríguez, Leyre López Antoñanzas, Javier Martín Monterrubio, Jose Maria Martinez-de-la-Casa, Lourdes Montero Cruces, Jesús Moreno Sierra, Jose Maria Muguerza, Alexia Victoria Paluso Montero, Natalia Pérez Romero, Adriana, Poch, Jaime Rodríguez de Alarcón, Adriana Ruano Campos, Rebeca Ruiz Roman, Patricia Saez Carlin, Cristina Sánchez Del Pueblo, Lidia Sotillo Valenzuela, Armando, Galvan, Miguel Ángel García Ureña, Enrique, González, Manuel Medina Pedrique, Alvaro Robin Valle de Lersundi, Carlos San Miguel, Juan, Aragón-Chamizo, Monica, Ballon, Jose, M Barrio, Beatriz Castro Catalan, Laura Cebolla Rojas, Renan Carlo Colombari, Miguel Cuende Diez, Paula Dujovne Lindenbaum, Oscar, Gil-de-Sagredo, Silvia Kayser Mata, Pablo Lozano Lominchar, Yeniffer Tatiana Moreno Salazar, Angela, Moreno-Gutierrez, Melanie, Morote, Uxue, Murgoitio, Nikolas Palma Caucig, Lucía Polanco Pujol, Alejandro, Prosperi, María Belén Ramírez Senent, Diego Fernando Ruiz Chiriboga, Mercedes, Sanz, Maria, Tudela, María Adrien Lara, Raquel, Alarza, Isabel Alonso Sebastian, Mariano Artés Caselles, Laura, Calles-Sastre, Marcos Casas Sánchez, Aritz Equisoain Azcona, Lucía, Fuentes, Lucia Gil Cidoncha, Sofía Herrero Gámiz, Eva Iglesias Garcia, Jose Luis Lucena De La Poza, Mª Eugenia Marín Martínez, Pilar Martín Rodrigo, Joaquin Manuel Muñoz Rodríguez, Verónica, Polaino, Alberto Pueyo Rabanal, Xabier Remirez Arriaga, Xiana, Rial, Miguel Sánchez Suárez, Maria Eugenia Torguet Muñoz, Borja Bazán Inostroza, Lara Blanco Terés, Alba Correa Bonito, Angela de la Hoz, Gustavo, Eisenberg, Javier Garcia Septiem, Jose Maria Lopesino, Rocio, Maqueda, Elena, Martin-Perez, Jose Luis Muñoz de Nova, Julia Revuelta Ramírez, Ana Rodríguez Sánchez, Álvaro Valdés de Anca, Laura Colao García, David Díaz Pérez, Enrique Esteban Agustí, Pablo Galindo Jara, Ana Belén Gallardo, Cesar, Garcia, Maria Gutierrez Samaniego, Miguel Angel Hernandez Bartolome, Lorenzo, Rabadan, Barriga Sánchez Raquel, Beatriz, Diéguez, Miguel, Hernández-García, Carolina Alfonso Carrillo, María Belén Alonso Bartolomé, Estibaliz, Alvarez, Mario, Alvarez-Gallego, Paula, Aragón-Ramos, Pablo Cesar Arteaga Asensio, Luis Asensio Gomez, Diego, Carrion, Nuria, Chavarrias, Alvaro de Arriba, Jose Antonio Gazo Martínez Gazo, Alberto Gegúndez Simón, Juan Gómez Rivas, Natalia Gonzalez Alcolea, Carolina, Gonzalez-Gomez, Sara Gortázar de Las Casas, María Alexandra Heras Garceau, Alicia Hernández Gutierrez, Luis, Lassaletta, Fuad Samir Lopez Fernández, Marta, Mancheño, Blanca, Mateos-Serrano, Isabel Pascual Miguelañez, Maria Fernanda Pedrero Escalas, Julio, Peñarrocha, Yolanda, Perez, Maria Isabel Prieto-Nieto, Teresa Rivera Schmitz, Laura, Rodrigáñez, Ines, Rubio-Perez, Isabel Sanchez Cuadrado, José Ignacio Sánchez Méndez, Jorge Fernando Tone, Carlos Toribio Vazquez, Aitor, Urbieta, Diego Córdova García, Francisca Garcia-Moreno Nisa, Laura, Jiménez, Inmaculada, Lasa, Belen, Matías-García, Fernando, Mendoza-Moreno, Marina Pérez González, Ana Sánchez Gollarte, Alejandro Sanchez Pellejero, Cristina Vera Mansilla, Rafael, Barberá, Lourdes, Montes-Jovellar, Sara Fra Fernández, Nicolas Moreno Mata, Barbara, Algar-Yañez, Gutiérrez, Bérénice, Olga De La Varga-Martínez, Paula, Fernandez-Valdes-Bango, Sandra Maria Gadin-Lopez, José María Martínez-Gómiz, Elena, Nieto-Moreno, Ana, Nieto-Moreno, Montserrat Ocampos Hernandez, Maria Laura Pelegrina-Lopez, Alicia Ruiz Escobar, Elena, Sáez-Ruiz, Beatriz, Vazquez-Rivero, Antonio, Lara, Belén Vielva Del Campo, Fernando Alcaide Matas, Simbad, Costas-Ochoa, José María García Pérez, Elizabeth, Marmol, Paula Troncoso Pereira, Maria Del Pilar Concejo Cutoli, Juan Ramón Gómez López, Juan Carlos Martín Del Olmo, Paloma Guillamot Ruano, Javier Páramo Zunzunegui, Antonio Albarracín Marín Blázquez, Alfonso, Aliaga-Sanchez, Marta María Arroyo Domingo, Miriam Artés Artés, Ana Isabel Avellaneda Camarena, Aida, Blaya, Emny Rochell Bobadilla Romero, Pedro Vicente Fernández-Fernández, Lorena Galindo Iñiguez, Víctor Javier García Porcel, Clara Giménez Francés, Antonio Javier Gomez Poveda, Rebeca Gonzalez Celdran, Francisco Miguel González Valverde, Laura Guillamon Vivancos, Elena, Gurrea-Almela, Alejandra Jara Maquilón, Jose David Jimenez Parra, Abd Al Aziz Lanagrán Torres, Raquel Lax Perez, Carmen Maria Lopez Lopez, Francisco, Machado, Alfonso Marco Garrido, Florencio Manuel Marin Martinez, Victoria Martínez Muñoz, Esther, Medina, Olimpia, Molina, José Manuel Muñoz Camarena, Julian, Onate, Pedro Antonio Parra Baños, Emilio Peña Ros, Enrique, Rubio, Marina Sánchez Robles, Carlos Sanchez Rodriguez, María Valero Soriano, María Teresa Yepes García, Felipe, Alconchel, Andrés Balaguer Román, Valentín, Cayuela, Ana, Conesa, Ana Delegido García, Pedro José Gil Vázquez, Paula Gómez Valles, Francisco, Gómez-Bosch, Vicente, J León-Muñoz, Francisco, Martínez, Alvaro, Navarro-Barrios, Tatiana, Nicolás-López, Pablo Ramirez Romero, Emiliano, Cano-Trigueros, María Concepcion Alonso González, Leticia Gómez Viana, Ana Pastor Zapata, Elisa Contreras Saiz, Tamara Díaz Vico, Maria, Fernandez-Hevia, Luis Joaquín García Flórez, Raquel, Rodríguez-Uria, Sandra, Sanz, Lorena, Solar-Garcia, Aida Suárez Sánchez, Jaume, Gelonch, Dietmar, Reinaldo, Miriam Abdulkarim Polo, Asier, Aguirre, Marta Alomar Bofill, Santiago, Baena, Ashish, Bartakke, Carmen Cabeza Oliver, Marta Castro Suárez, José Andrés Cifuentes Rodenas, Olga Claramonte Bellmunt, Ant Onia Crespí Mir, Anabel De La Llave Serralvo, Mar, Escales, Isabel Rosa Fernández Burgos, Pablo Gandia Gonzalez, Juan Lliteras Jorge, María Cristina Martínez Canto, Javier, Mata, Andreu, Morell, Naila, Pagès, Sara Pérez Palao, Cristian Plaza Valiente, Catalina Ramon Barcelo, Carmen Reyero Fernández, Albert Reyes Claret, Leticia Rodriguez Vaquero, Maialen Saez de Vicuña Salinas, Pilar Santos Cidon, Concepcion, Segura, Aina, Serra, Maria Serra Guivernau, Maria Soler Pedrola, Marta, Tasende, Marta Torrent Lluch, María Inmaculada Valldeperas Hernández, Rosa-Maria, Yañez-Lpez, Andrea, Craus-Miguel, Laura Fernández Vega, Natalia Pujol Cano, Juan José Segura-Sampedro, Laura Colet Oliver, Ivan Dot Pascuet, Mireia, Duart, Isabel Tello Galindo, Eduardo Arrea Salto, Jaume Cámara Cabrera, Marta Camats Terré, Juan Gabriel Castro Ríos, Marta de la Rosa-Estadella, Anna, Fernandez-Colorado, Anna, Gasulla-Rodriguez, Antonio, Gimenez-Gaibar, Elena, Gonzalez, Yeray Maldonado Sotoca, Matilde, Molina-Corbacho, Montserrat Monfort Mira, Josep, Rodoreda, Marta Santos Espí, Arnau Verdaguer Figuerola, Elisa Angela Diego-Alonso, Jaime, López-Sánchez, Luis, Muñoz-Bellvis, Jacobo, Trebol, Borja, Aguinagalde, Cristina Gabriela Alzate Arsuaga, Ainhoa Andres Imaz, Iñigo, Arana, Coro Aranzabal Urrutia, Mikel, Armendariz, Lorena, Arrabal, Iñigo, Augusto, Adolfo, Beguiristain, Laura, Busto, Ainhoa, Cuevas, Itziar De Ariño, Alejandro, Elúa, Leticia, Fernandez, Arantza, Fernandez-Monge, Lander, Gallego, Alba, Garcia, Amaia Garcia Dominguez, Gregorio, Garmendia, Carmen, Grañén, Pelayo Hevia Rodríguez, Maria, Iraola, José Miguel Izquierdo, Aintzane, Lizarazu, Jon Ander Lizarbe, Claudia Cristina Lopes Moreira, Iker, López, Ruth Marquina González, Tania, Pastor, Adrián Recio Ayesa, Ana Paula Riverola Aso, Carballo, Rodríguez, Araceli, Rodrìguez, Maria Inmaculada Ruiz Montesinos, Patricia, Torres, Jose, Undabeitia, Ainara, Villafruela, Maria Barrionuevo Ramos, David, Blanco, Marta, Calderón, Eva Corral Rubio, Angel, Cuadrado-García, Daniela, Cubek, Ignacio, Fariña, Maria Fernandez LLorente, Natalia Flores Amador, Mariana García Virosta, Luis Garcia-Sancho Tellez, Adelina Gonzalez Martinez, María, Hernandez, Rubén Herreros Ruiz-Valdepeñas, Carmen Jimenez Sanchez, Eduardo Llamazares Cobo, María, López, Javier, López-Martin, Teresa Martínez Marivela, Luis Miguel Martinez Parra, Paloma Maté Mate, Paloma, Medrano, Manuel Moriche Carretero, Sara Núñez O'Sullivan, Manuel Ortega Oria de Rueda, María Begoña Pastor Nieto, Clara, Pérez, Antonio, L Picardo, Remedios Revilla Amores, Carmen Rodríguez Haro, Jose Alberto Rojo López, Fatima Sanchez Cabezudo Noguera, Cristina, Sanz, Daniel Serralta de Colsa, Cristina Valor Garcia, Marta Velasco Martinez, Iván Andújar Lara, Aranzazu, Calero-Lillo, Enrique, López-Ruiz, Alberto Díaz García, Alejandro Menéndez Moreno, Luis Eduardo Pérez-Sánchez, Ángela, Pascual, Miguel Adeba García, Marta Alonso Fernández, Javier Alvarez Gama, Roberto, Ballestero, Loreto Berjon De La Vega, Paola Calleja Hermosa, Mariana, Carrillo-Rivas, Alfonso, Casado, Andrea, Cerveró, Bonifacio Cimadevilla Calvo, Patricia Corriols Noval, Paloma de la Dehesa Cueto-Felgueroso, Miren Jasone Diez Zapirain, José Estevez Tesouro, José Antonio Fernández-Dívar Sánchez, Lucia Garcia Alcalde, Juan García Cardo, Tito García Moreno, Daniel, García-López, Belen Garcia-Montesinos Perea, Miren Gonzalez Benito, Rocio, Gonzalez-Aguado, Miguel Ángel Gordo Vega Gordo-Vega, Jose, Gutierrez-Banos, Jaime Jimeno Fraile, Yolanda Jubete Castañeda, Patricia Lopez Gomez, Antonia Jesús López López, David Mato Mañas, Carmelo, Morales-Angulo, Dieter, Morales-Garcia, Sara, Naranjo, Jose Luis Rabago, Jose Manuel Rabanal, Rocio Revuelta Zorrilla, Adriana Reyes Echeverría, Juan Carlos Rodríguez-Sanjuán, Juan Ramón Sanz, Isabel Simal Badiola, Guillermo, Tejón, Enrique Toledo Martínez, Raquel Varea Malo, Begoña, Fadrique, Tania, Funes, Elena González Revilla, Isaias, Alarcón, Daniel Aparicio Sánchez, Pablo Beltran Miranda, Carmen, Cepeda-Franco, María Josefa Cuevas López, Sandra, Dios-Barbeito, Virginia María Durán Muñoz-Cruzado, Carlos Gonzalez De Pedro, Rosa, M Jimenez-Rodriguez, Francisco, Manresa-Manresa, Gabriel, Marin, Cristobalina, Martin-Garcia, Sara, Martínez-Núñez, Juan Manuel Martos Martinez, Lucas, Mengíbar, Felipe Pareja Ciuro, Eduardo Perea Del Pozo, Veronica Pino Diaz, José, Pintor-Tortolero, Claudia, Quintero-Pérez, Maria Luisa Reyes Diaz, Mercedes Rubio Manzanares Dorado, Alejandro Sanchez Arteaga, Ana, Senent-Boza, Luis, Tallon-Aguilar, Jose, Tinoco-Gonzalez, Luis-Cristobal, Capitan-Morales, Juan Cintas Catena, Javier, Valdes-Hernandez, María Del Campo Lavilla, Alina López De Fernández, Miriam Abellan Lucas, Alba Diaz Padillo, Maria Gómez Romero, Linda Grace Puerto Tamayo, El Mostafa El Yaqine Er Raoudi, Melody García Domínguez, María Ángeles Gascón Domínguez, Marta González Pérez, Alba Hernáez Arzoz, Joana San Anton, Cristian, Ruminot, Hander Guillermo Acosta Diaz, Daniella, Laguado, Kristina, Aghababyan, Alba, Jr, Enrique, Artigues, Rocío, Belda, Miguel, Beltran, Jose Ignacio Blanes, Elena Campos Carot, Miriam, Cantos, Laura, Costa, Carolina Ferrer Gomez, José María Gallego Sánchez, Oscar, Gil-Albarova, Juan, Gilabert-Estellés, Emilio Lopez Alcina, Isabel López Sánchez, Severiano Marin Bertolin, Carolina, Martinez-Perez, Antonio Melero Abellán, Claudia Mulas Fernández, Beatriz, Novoa, Ruth, Nuñez, Pablo Renovell Ferrer, Guijarro-Jorge, Ricardo, Carolina Soledad Romero Garcia, Miguel Sanfeliu Giner, Silvia, M West, Enrique, Zapater, Ignacio, Miranda, Ana, Monís, Alejandro Roselló Añón, María José Sangüesa, Jorge Sanz Romera, Marcos, Adrianzén, Maria Barrios Carvajal, Mireia, Bauzá, Ana Benítez Riesco, Jose Antonio Carbonell Lopez, María-Carmen, Fernández-Moreno, Ricardo Gadea Mateo, Francisco, Garcia, Maris Luisa García-Pérez, Luisa Paola Garzon, Ana, Izquierdo, Maria Lapeña Rodríguez, Carlos, León-Espinoza, Fernando, Lopez, Rosa Martí Fernández, Sara Martínez Castro, Berta Monleón López, Isabel Mora Oliver, David, Moro-Valdezate, Ernesto Muñoz Sornosa, Sara Palomares Casasús, Leticia Pérez Santiago, Mara Albert Fort, Reyes, Balanzá, Lorena Bermell Marco, Carla Carratalá Pérez, Claudia Pilar Clemente Tomas, Marta, Córcoles, Jose Ángel Diez Ares, Carlos Domingo Del Pozo, Nuria Estellés Vidagany, Gonzalo, Garrigos, Mar Gimeno Gimeno Vicente, Blanca Alastrue Giner, Segundo, Gomez-Abril, Paloma, Gonzalez, Paula Gonzálvez Guardiola, Guillermo Sebastian Martínez Fernández, Charo Martínez García, Lucía, Martínez-Costa, Luz María Moratalla Charcos, Sergio Navarro Martínez, Carmen, Payá-Llorente, Álvaro Pérez Rubio, Nuria, Peris, Eduardo Picazo Pineda, Jordi Planelles Gómez, Francisco Ripoll Vidal, Andrea, Roca, Enrique, Salmerón-González, Raquel Segura Roselló, Ramon Trullenque Juan, Cristina Verdejo Gimeno, Jose Miguel Zaragozá García, Gema Zomeño Bravo, Marcos Bruna Esteban, Hanna, Cholewa, Milton de Jesus, Matteo, Frasson, Luis Oliver García, Héctor, J Aguado, Antonio Jose Alonso Villalba, Francisco, Ardura, Carmen Elena Badillo Bercebal, María Bedate Núnez, Alvarez-Ramos Begoña Aranzazu, Juan Beltrán de Heredia, Hugo, Bermejo, Juan Berrocal Cuadrado, Maria Bragado González, Juan, Bustamante-Munguira, Raul Calvo Gonzalez, Yolanda, Carrascal, Ana Belén Casas Marcos, María Carmen Cervera, Sergio Chávez Valladares, Ángel Cilleruelo Ramos, Susana, Cortes, Jesús, Crespo-Sanjuán, María, Cuaresma, Luis Antonio Cuellar Martin, Carlos Ferreras García, Alvaro, Fuentes-Martín, Abel, Ganso, Elena García García, Luis, Garcia-Florez, Virginia, Garcia-Virto, Juan, Gatón, Julio Alberto Gobernado Tejedor, Tania Gómez Sanz, Jose Ignacio González Martín, María Begoña Gregorio Crespo, Ana Herranz Arriero, Jose, Herreros, Marta Ibáñez Nieto, César, Infante, Carlos, Jezieniecki, Moises, Juarez, Gregorio de Jesus Labrador Hernandez, Ana Patricia Legido Morán, Ricardo León Fernández, Alejandro, Leon-Andrino, Almudena, Llorente, Maria Lopez Pais, Mauricio Loucel Bellino, Sergio, Martin, Miguel Angel Martin-Ferrero, Gonzalo Martinez Municio, Elvira Mateos Alvarez, José María Matilla, Luis María Merino Peñacoba, Mario, Montes-Manrique, Fernando Natal Álvarez, David, C Noriega, Henar Nuñez Del Barrio, Francisco Javier Ortiz de Solórzano Aurusa, Lucía, Pañeda, Victoria Pascual Escudero, Miguel Pascual Samaniego, Adela, Pereda, Marta Pérez Febles, Laura, Pesquera, Maria, Plata, Emma Puertas Ruiz, Mario, Rodriguez-Lopez, Alejandro Romero de Diego, Ana, Ruano, María Ruiz Soriano, Cristina Sánchez Torralvo, Silvia Santiago Maniega, Bárbara, Segura-Méndez, Clarisa Simon Perez, José, Soro-García, Paula Suárez Mansilla Suárez-Mansilla, Jeancarlos Trujillo Díaz, Mª Esther Valsero Herguedas, Andrea Vazquez Fernandez, Eduardo Velasco García, Ana, Zabalza, Álvaro Zamora Horcajada, Fernando Acebes García, Enrique Asensio Díaz, Martín, Bailón, Alejandro David Bueno Cañones, Alvaro Centeno Velasco, Ekta Choolani Bhojwani, Fernando Labarga Rodríguez, Sara, Mambrilla, Pablo, Marcos-Santos, Toledano, Miguel, David Pacheco Sánchez, Baltasar, Pérez-Saborido, Pilar, Pinto, Katherine, Plua, Javier Sanchez Gonzalez, Vicente, Simo, Rosalía Velasco López, Sandra Veleda Belanche, Fabiola Eugenia Michel Campos, Iciar Muñoz Lindez, Maria, Balluerca, Maite, Camuera, Pablo, Helguera, Imanol, Herrero, Patricia Paunero Vazquez, María, Sánchez-Rubio, Isami, Soeda, María Dolores Arribas Del Amo, Vicente Manuel Borrego Estella, Estefania, Casas, Néstor Castán Villanueva, Daniel Delfau Lafuente, Elena Delgado Blanco, María, Domingo, Ismael Gil Romea, Azucena, Gonzalo, Emilio Lagunas Lostao, Noelia Lete Aguirre, Yaiza Martinez Lahoz, Jesús Víctor Pérez-Tierra Ruiz, Maria Del Mar Soriano, Isabel Valero Lázaro, Esmeralda Carnicer Escusol, Guillermo Pola Bandres, Juan Luis Blas Laina, Beatriz, Cros, Patricio Andrés Freile Pazmiño, David, Garcia-Aguilera, Ana Mejía Casado, Ana, Nogués, Issa Talal El-Abur, Carlos, Yánez, Isabel Gascon Ferrer, Carlos, Gracia-Roche, Ursula María Jariod Ferrer, María Victoria Simón Sanz, Tomas, Uson, Waseem, Ahamed, Sumudu, Jayasinghe, Eranda, Karunadasa, Prathibha, Nelihela, Sujeewa Priyantha Bandara Thalgaspitiya, Dickson, Wickramarathna, Nagenthiram, Harivallavan, Pirashanthan, Nagarasa, Eranga, Perera, Kanapathipillai, Piratheep, Vithranage Srimantha Dewsiri Rodrigo, Meera, Thayalan, Rajendram, Thayaparren, Arulprashanth, Arulanantham, Kanishka De Silva, Gagana, Ganga, Anuja Nadeeshan Kumarasinghe, Mahanada, Udukala, Koculen, Vimaleswaran, Prashanthan, Yogarajah, Ravindri, Jayasinghe, Probhodana, Ranaweera, Mohamed, Rishard, Dharmabandhu, N Samarasekera, Sanjeewa, Seneviratne, Sivasuriya, Sivaganesh, Chamal, Fernando, Nishantha, Mendis, Balasingam, Balagobi, Balasupramaniam, Sathesan, Lanka, Dasanayake, Malitha, Patabendige, Wickramasooriya, Dj, Kugarajh, Ganeshapillai, Sathyamoorthy, Prasanna, Dileepa, Ediriweera, Sumudu, Kumarage, Asanka, Jayawardane, Athula, Kaluarachchi, Pituwala Liyanage Adithya Sirisena, Abubakr, Abubakr, Hozifa, Mohamed, Ismail, Mustafa, Mogahid, Sharfeldein, Samir, Ismail, Reem, Musa, Monira, Sarih, Mussab, Abaker, Eman Adam Abdalla, Mohamad, Abdelbagi, Alsafe, Adlan, Ahmed, Alnaeem, Safa, Atyah, Yasir, Awad, Rsheeda, Dawelbait, Mohamed El Hag, Ibrahim, Elbashir, Sami, Eldirdiri, Samwal, Eldirdiri, Mohammed Eltahier Abdalla Omer, Lana Abdalgadir Ahmed Mohamed, Hiba Hassan Rehmtallah Ahmed, Mohammed Balla Yousif Balla, Abdulmoiz, Aljafari, Abdulmalek, Aljafari, Elsagad, Mohamed, Abdulkader, Mohammad, Abdulkader, Shaar, Mohamed Nafea Shaar, Maab Hussein Yousif Elhafiz, Mohammed Husien Yosif Elhafiz, Abubakr Ali Mohammed Alhassan Humidan, Almigdad, Ali, Hisham, Eljack, Mohamedyasin, Elrashid, Manhal, Ahmed, Albrra, Alhag, Douaa, Ali, Mohammed Ahmed Babikir, Imad, Bakheit, Hytham K, S Hamid, Sami, Mohamed, Walid, Shaban, Nidhal, Siddig, Mohamed, Suliman, Rihab Yasir Abdelmagid, Abubaker, Yassin, Omer, Abbas, Eltahir, Abdelrahim, Muhammed, Ahmed, Mohamed, Elobaid, Adil, Hashim, Ali, Mohamed, Omer, Mohamed, Khalid, Osman, Abdallah, Yousif, Safaa, Abdulaal, Marwa, Elsadig, Mohammed, Hussain, Malaz Amir Ataalmanan, Doha Amir AtaAlmanan, Tebyan Amir AtaAlmanan, Alaa, Elgaili, Maria, Mohamed, Usra, Omara, Alkhansa, Osman, Amna, Osman, Safaa, Saad, Abdelkareem, Ahmed, Ali Adil Ali Karar, Aya, Alhassan, Mohanad, Alsidig, Mohamed, Eljack, Mohammed Ibrahim Mohammed Ali, Awad Kamal Awad Osman, Liena, Mohamed, Samah Ibrahim Omer Mohamed Osman Mohamed Osman, Altayeb, Mohammed, Ayman, Mohammed, Khadija, Muhmmed, Eltahir, Musa, Egbal Sahal Abdelmajed, Khalid Z M, Y Hamid, Omnia M, M Yousif, Mahmoud, Saleh, Osman, Bashir, Yassein, Elhussein, Omar, Madani, Eva, Angenete, Jennifer, Park, Lars, Gillberg, Monir, Jawad, Linas, Pieteris, Yousif, Saeed, Sergej, Safonov, Martin, Spångfors, Henrik, Andersson, Hans, Bahlmann, Karin Björnström Karlsson, Michelle, Chew, Lara, Daham, Lina De Geer, Helen, Didriksson, Gunilla, Gagnö, Carina, Jonsson, Anna, Oscarsson, Pamela, Buchwald, Mathilde, Delorme, Marie-Louise, Lydrup, Shahin, Mohseni, Arvid, Pourlotfi, Souheil, Reda, Kajsa, Anderin, Nina, Blomme, Josefin, Segelman, Malin, Simlund, Anders, Thorell, Fredrik, Wogensen, Daniel, Danielsson, Peter, Elbe, Rebecka, Hultgren, Boel, Hynning, Fredrik, Klevebro, Karin, Lind, Ebba, K Lindqvist, Carl, Montan, Ernesto, Sparrelid, Clara Svenberg Lind, Jeremy, Wales, Andreas, Älgå, Martin, Nordberg, Emil, Pieniowski, Ioannis, Gkekas, Niklas, Löfgren, Karolina, Niska, Robert, Zürner, Silvio, Däster, Otto, Kollmar, Savas, Soysal, Stephanie, Taha-Mehlitz, Athanasios, Tampakis, Dominik Valentin Flury, Marie, Heyne-Pietschmann, Gregor Jan Kocher, Ana, M Calinescu, Barbara, Wildhaber, Markus, Gass, Jürg, Metzger, Andreas, Scheiwiller, Lukas, Briner, Oliver, Dwidar, Steven, Grandjean, Pietro, Ricciardi, Alexandra, Calmels, Christodoulou, Michel, Morena, Antonilli, Dimitrios, Christoforidis, Alessandra, Cristaudi, Jacopo, Galafassi, Maria Luisa Gasparri, Francesco, Mongelli, Martino, Munini, Andrea, Papadia, Sotirios Georgios Popeskou, Alex, Alfieri, Thomas, Bächler, Matteo, Giardini, Christian, Gingert, Laura, Guglielmetti, Inna, Meyer, Tobias, Müller, Daniel, Schöni, Folco, Solimene, Frank, Weidner, Marco, Bueter, Daniel, Gero, Amelie, Müller, Carmen, Portenkirchner, Andreas, Thalheimer, Jeannette, Widmer, Ahmad, Hmaideh, Alaa, Kour, Saleem, Swaes, Omar, Alannaz, Ramez, Aljasem, Ezeddin, Dabbagh, M Wafa Hamoud Alhussein, Amr, Hamza, Mazen, Mohammad, Abd El-Fattah Mouhandes, Mohamad, Shareeda, Mohammad Nour Shashaa, Mousa, Sifat, Sheraa, Tahhan, Rahaf, Toutounji, Mohamed, Abdulrahman, Albaraa, Abdulsalam, Ziad Al Jarad, Hala, Alayyoubi, Dina, Alfarra, Ahmad, Alhamid, Mahmoud, Alnasser, Mulham, Gharib, Ruwaid, Gharib, Obaida, Kabel, Osama, Kherallah, Abdulqader, Klaho, Mohamed Shukri Najjar, Ahmad, Razouk, Joud, Shiekhoni, Wael, Alkhaleel, Amira, Almosa, Mohammad, Aloulou, Maen, Alzaeem, Khaled, Arnaout, Muhamad Zakaria Brimo Alsaman, Mohamad, Estanbouli, Hanadi, Hawa, Ahmad Nbrass Kabawi, Ghina, Maarawi, Yehia, Mashhadany, Sana Shaikh Torab, Waleed, Abd, Tayma Abd Alghafour, Hani, Abdalnour, Nazeeh Al Aktaa, Marwan Al Aliwy, M Maher Al Arje, Tasneem Al Najjar, Ahmad, Al-Mouakeh, Ahmad, Aldakhil, Aos, Alhamid, Hasan, Alhasan, Mohamad Shadi Alkarrash, Jumaa, Alkhamis, Sara, Alshekh, Ahmad Yamen Arnaout, Oula, Azizeh, Mohammed, Dalaleh, Aghyad, Danial, Zain, Douba, Raghad, Ghadri, Mohammad Maen Ghannam, Anas, Ghawi, Luma Haj Kassem, M Yasser Halwani, Shahed, Hamadieh, Mohammad, Hanino, Ala Aldeen Hasan, Haya, Jawish, Nasr Ullah Kabbani, Saadullah, Kabbany, Mohamad, Kadi, Lama, Kadoura, Ahmad Amir Kayali, Ammar, Kayyali, Aya, Kelzia, Amana, Kezze, Abdullah, Khalaf, Maymona, Khayata, Mohammad Nour Kitaz, Mohammad, Kour, Raghad, Makki, Ruqaya, Masri, Joseph, Masri, Noor, Masri, Muhammad, Mazketly, Shiar, Mustafa, Ezzeldin, Nashed, Yaman Qoudra Danial, Hasan, Raslan, Rima, Salem, Mohammed Asaad Salem, Thabet Sayed Bakir, Manaf, Sharabaji, Majd Sheikh Alganameh, Duaa Sheikh Kadro, Joudy, Shurbatji, Mohammad Noor Sultan, Dana, Sultan, Hala, Swied, Bakri Tarras Jarkas, Tayf, Toutounji, Fadi, Ward, Rama, Zazo, Aya, Zazo, Zainab, Zeino, Mohamed, Alaktaa, Wael, Alsado, Hala, Fares, Nouran, Hawa, Hamza, Ibrahim, Abdulmonem, Kawas, Mourad, Niazi, Bayan, Toutounji, Mohammad, Abdow, Mohamad, Ahmad, Tareq, Ahmad, Rawan Al Azhar, Hiba Al Hage Diab, Rahaf Al Mulke, Mohammad, Al-Jadaan, Ahmad, Alhussein, Zahra, Alnajem, Omar, Alneser, Bayan, Alsaid, Elias, Azar, Lubna, Bakr, Ammar, Hamza, Yara, Houdifa, Sami, Jomaa, Samer, Kefo, Hiba, Mardini, Alaa, Mohammad, Fadi, Rayya, Fatima, Razzouk, Mohannad, Saleh, Anwar, Shamandi, Ammar Youzkatli Alkhatib, Omar Abdul Salam, Dany, Ajami, Mohammad, Alhamid, Ahmad, Alkhaledi, Danny, Hadidi, Massa, Jabra, Mamdouh, Kallas, Antoine, Laktine, Joelle, Naem, Naya, Naoum, Ghena Mohammed Fawaz Ashour, Ahmad, Alhouri, Deema, Fallouh, Ahmad, N Mohammad, Ahmad, Rmman, Ali, Slitin, Christine, Tanos, Ibrahim, Wakim, Hanaa, Zahrawi, Majd, Abouassi, Layth, Abouassi, Ayham, Aboutrab, Basel, Ahmad, Ahmad Mustafa Ahmad, Aya, Ahmad, Afaf, Ahmad, Mohamad, Alabras, Mohammad, Albasheer, Ola, Alkasser, Mhd Khaled Alkasser, Ali, Alkhdor, Marah, Azkoul, Mohammad Karam Chaaban, Haya, Deeb, Basel, Jazieh, Basel, Kouz, Youssef, Kozah, Raied, Mohamad, Ammar, Mohammad, Mhd Zied Nasri, Mohammed Mouaz Shebani, Mohammed, Shwin, Alaa, Sommaq, Amal, Youssef, Tala Al Asadi, Suhad, Alkhateb, Rasha Khalil Alsayyad, Roula, Altom, Mhd Amin Alzabibi, Batoul, Bakkar, Hlma, Ismail, Salma Khadem Alsrouji, Sara, Melhem, Mohamad, Sankari, Mosa, Shibani, Noura, Shujaa, Ibrahim, Adham, Salma, Al-Houssami, Maram, Balouli, Yazan, Rahmeh, Simon, Yanni, Sally, Yousef, Aline, Ahmad, Marah, Ali, Abdulrahman, Almjersah, Aya, Almoustafa, Hiba, Dahhan, Bashar Haj Hassan, Alaa, Hamdan, Salah, Hammed, Rawan, Harfoush, Rama, Hasan, Natalie, Jarkas, Moufid, Mahfoud, Ahmed, Moussa, Alaa, Sulaiman, Siba, Suliman, Yu-Ning, Hu, Jun-Neng, Roan, Meng-Ta, Tsai, Yi-Chen, Wang, Thammawat, Parakonthun, Nicha, Srisuworanan, Voraboot, Taweerutchana, Somcharoen, Saeteng, Sophon, Siwachat, Apichat, Tantraworasin, Danielle, Dimsoy, Shane, Khan, Akash, Ramsaroop, Shivanand, Ramsubhagh, Karim, Ayed, Oussama, Baraket, Mohamed Hedi Ghalloussi, Abbassi, Imed, Nahla, Kechiche, Waad, Farhat, Ammar, Houssem, Erdal Birol Bostanci, Volkan, Oter, Erol, Pişkin, Cihangir, Akyol, Sibel, Demirel, Mehmet Ali Koç, Can, Konca, Özge, Yanık, Basak, Bolukbasi, Huseyin, Gobut, Emre, Gülçek, Kerim, Karabulut, Ramazan, Kozan, Farshad, Noori, Elif, Özeller, Can, Şahin, Ali, Yalcinkaya, Mesut, Yavaş, Aydın, Yavuz, Utku, Akgor, Omer, Cennet, Hilmi Anil Dincer, Murat, Gultekin, Nazlı, Orhan, Mustafa, Oruç, Serdar, Culcu, Lütfi, Doğan, Cemil, Yüksel, Alp, Yildiz, Aybala, Yildiz, Perihan, Ekmekçi, Baturay Kansu Kazbek, Ülkü Ceren Köksoy, Deniz Serim Korkmaz, Zeynep Şahan Çetinkaya, Elif Aybeniz Yildirim, Hakan, Yilmaz, Metin, Yığman, Nasuh Utku Dogan, Selen, Doğan, Mehmet, Sakinci, Ozgen, Isik, Murat, Şen, Tuncay, Yılmazlar, Utku, Özgen, Ugur, Sungurtekin, Yener, Aydin, Ilker, Ince, Ali Bilal Ulas, Hüseyin Cahit Yalçın, Mehmet, Kaplan, Tuğba, Kaplan, Elif Tugce Kaplan, Afag, Aghayeva, Bilgi, Baca, Inci, Sahin, Zumrud, Aliyeva, Akif Enes Arikan, Erman, Aytac, Onur, Dülgeroğlu, Volkan, Ozben, Cihan, Uras, Emre, Sivrikoz, Ismail Ahmet Bilgin, Bahadır, Bozkırlı, Güralp Onur Ceyhan, Ismail, Hamzaoglu, Halil, Kara, Tayfun, Karahasanoğlu, Olus, Api, Mehmet, Ceyhan, Aylin Pelin Cil, Telce Aysen Gurbuz, Cumhur, B Lent Urman, Ahmet, Akbas, Yunus Emre Aktimur, Yuksel, Altinel, Fikret, Calikoglu, Serdar, Demirgan, Ahmet Guray Durmaz, Gulcin, Ercan, Candas, Ercetin, Hasim Furkan Gullu, Nadir Adnan Hacım, Serhat, Meriç, Kamil, Özdoğan, Merve, Tokocin, Mehmet Alim Turgut, Talar, Vartanoglu, Hakan, Yigitbas, Hüsnü, Aydın, Ece, Bahçeci, Mestan, Bilmez, Elif, Binboğa, Sinan, Binboga, Gokhan, Demirayak, Bengi, Demirayak, Keziban, Doğan, Ahmet Cem Dural, Murat, Ekin, Sina, Ferahman, Fatih, Guven, Mehmet, Karabulut, Sema, Karakaş, Selçuk, Köse, Ayşe Büşra Önder, Ismail Umut Onur, Nuri Alper Sahbaz, Levent, Yaşar, Ulviye, Yigit, Güneş Özlem Yıldız, Ümmühan Zeynep Bilgili, Bayram, Doğan, Cevper, Ersoz, Abdullah, Ilktac, Senad, Kalkan, Eyyüb Selim Ünlü, Halil, Alis, Süleyman, Büyükaşık, Burak, Kankaya, Oguzkagan, Batikan, Ensar, Çakır, Musa Murat Caliskan, Mahmut Emin Çiçek, Anil, Demir, Selim, Doğan, Emre, Erdoğan, Mert, Güler, Muhammed, Gürlük, Ufuk Oguz Idiz, Rozan, Kaya, Cebrail, Oğuz, Ömer Akay Ömer, Serkan Süleyman Özpak, Hüsnü, Şevik, Mert Mahsuni Sevinc, Cihad, Tatar, Oğuzhan, Tekin, 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Yanar, Ahmet, Akmercan, Gül, Çakmak, Tuncay, Kötan, Tunc, Lacin, Ayten, Saracoglu, M Umit Ugurlu, Tumay, Umuroglu, Tevfik Kıvılcım Uprak, Esra Yamansavci Şirzai, Bedrettin, Yıldızeli, Elif, Baran, Emre, Bozkurt, Sinan, Ömeroğlu, Mert, Tanal, Aydın Eray Tufan, Mehmet, Uludag, Gürkan, Yetkin, Murat, Kalın, Omer Faruk Ozkan, Hanife Şeyda Ülgür, Tayfun, Bisgin, Muhammet Berkay Sakaoglu, Selman, Sökmen, Deniz, Caglar, Candan, Cicek, Demre, Delipinar, Emre, Divarci, Egemen, Ozdemir, Hilmican, Ulman, Seda Dilek Yetut, Feyme, Zafer, Ismail, Sert, Burçin, Abud, Murat, Akalin, Cengiz, Aydin, Bulent, Calik, Emine Burcu Cigsar, Semra Demirli Atıcı, Ayberk, Dursun, Mustafa, Emiroglu, Hüseyin, Erdinç, Tayfun, Kaya, Gizem, Kilinc, Yasemin, Kirmizi, Merve Dilara Öney, Mustafa Onur Oztan, Semra, Salimoğlu, Cem, Tugmen, İbrahim, Uyar, Sertaç Ata Güler, Alican, Güreşin, Ozan Can Tatar, Nihat Zafer Utkan, Kemal, Arslan, Mustafa Bilal Hamarat, Ismail, Hasirci, Mehmet Serkan Ozkent, Mehmet Eşref Ulutaş, 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Malaz, Abbakar, Vanessa, Badas, Radu, Chirvasuta, Joe, Drybrough, Alexandra, Hamshere, Annabelle, Harrison, Rebecca, Ireson, Nelson, Kamali, Abigail, Lau, Sumant, Luhana, Luisa, Macdonald, Barbara, Ribeiro, Alistair, Savage, Tanisha, Sharma, Paul, Swift, Rachel, Taute, Stephanie, Alford, Chase, Elswick, J Quentin Clemens, John Michael DiBianco, Anna, Faris, Mark, Hemmila, Giulia, I Lane, Lena, Napolitano, Jane, J Wong, Shelly, Abramowicz, Dina, Amin, Steven, Roser, Daniel, Beswick, Elisa, Birnbaum, Khaled, Campa, Carolyn, Chabuz, Brandon, Chapman, Nicole, Christian, Marco Del Chiaro, Adam, Dyas, Anna, Gergen, Anne, Getz, Ana, Gleisner, Ryan, Griffin, Laura, Harmon, Scott, Hirsch, Victoria, Huynh, Juan Pablo Idrovo, Laura, Leonard, Helen, Madsen, Robert, Mcintyre, Robert, Meguid, Kenny, Rodriguez, Richard, Schulick, Christopher, Scott, Lauren, Steward, Camille, Stewart, Malcolm, Su, Sarah, Tevis, Daniel, Thieu, Shane, Urban, Catherine, Velopulos, Jon, Vogel, Thomas, Vogler, Kristen, Vossler, Michael, Weyant, Franklin, Wright, Erika, Bengtson, Mary, Bokenkamp, Hannah, Chacon, W Drew Fielder, Alex, Haynes, Charlotte, Heron, Charles, Hill, Cole, Holan, Hannah, Kay, Brian, Kelley, Sabino, Lara, Kathryn, Mcelhinney, E Charles Osterberg, Sharmila, Paul, Christopher, Riley, Ayane, Rossano, Romil, Shah, Ifeoluwa, Shoyombo, Pooja, Srikanth, Pedro, Teixeira, Marc, Trust, Marian, Williams-Brown, Benjamin, Bigelow, Ijezie, Ikwuezunma, Amit, Jain, Harsha, Malapati, Ivy, Mannoh, Adam, Margalit, Sarah, Rapaport, Srikrishna Vangipuram Suresh, Dominique, Vervoort, Lekha, Yesantharao, Zhang, Bo, Hossam, Abdou, Megan, Anders, Jose, Diaz, Michael, Mazzeffi, Peter, Rock, Salim, Afshar, Andrea, Balthazar, Laura, Carlson, Karen, Carver, Michael, Kurtz, Craig, D McClain, Meena, Nathan, Caleb, Nelson, Nathalie, Roy, Rachel, Saunders, Amir, Taghinia, Vivian, Williams, Allison, Brown, Zara, Cooper, Joshua, Jolissaint, David, Mahvi, Barbara, Okafor, Chandrajit, Raut, Vanessa, Roxo, Ciersten, Burks, Allen, Zhou, Djanira, Fernandes, Maha, Haqqani, Nicolette, Jabbour, David, Novikov, Joseph, Sabra, Paul, Tornetta, Lauren, Tracy, Keianna, Vogel, Joanna, Wang, Shawn, Wang, Shaun, Wason, Emily, Berner, Ander Dorken Gallastegi, Mohamad El Moheb, Anthony, Gebran, Marilyn, Heng, Santiago Lozano Calderon, Michael, Mctague, Christopher, Melnic, Andy, Park, Anna, Goldenberg-Sandau, Rebecca, Platoff, Lisa, Shea, Debra, Manning, Romeeka, Perkins, Samuel, Ross, Kyle, Thompson, Grace, Chang, Dustin, Dehart, Jared, Ourieff, Rosalinda, Alvarado, Anuradha, Bhama, Daniel, Deziel, Amir, Dorafshar, Henry, Govekar, Brian, Gulack, Dana, Hayden, George, Kokosis, Andrea, Madrigrano, Keith, Millikan, Jonathan, Myers, Cristina, O'Donoghue, Philip, Omotosho, Sam, Pappas, Srikumar, Pillai, Thea, Price, Scott, Schimpke, Ami, Shah, Deana, Shenaq, Nicole, Siparsky, Alfonso, Torquati, Peter, Tsambarlis, Srinivas, Vourganti, Al-Faraaz, Kassam, Ralph, Quillin, Mauro, Bravo, Elyad, Ekrami, Kai, Li, Alparslan, Turan, Cassie, Decker, Elizabeth, A Hennessy, Thomas, Schroeppel, Zachery, Stillman, Gary, Schwartz, Salah, Aoun, James, Caruso, Clay, Burlew, Julie, Clark, Kendyll, Gartrelle, David, Kwon, Kristin, Colling, Andrew, Barbas, Raquel, Bartz, Sarah, K Dotters-Katz, Tressa, Ellett, Etienne, Flamant, Hesham, Gabr, Dilraj, Grewal, George, Kasotakis, David, Kerr, Vijay, Krishnamoorthy, Alexander, Lazarides, Justin, Ma, Sachin, Mehta, Lucy, Meyer, Courtney, Mitchell, Demetrios, Moris, Diego, Schaps, Zohal, Ghulam-Jelani, Motasem, Refaat, Torre, Soderlund, Amna, Ali, Airi, Katoh, Krista, Kaups, Leigh Ann O'Banion, Yazen, Qumsiyeh, Jessica, Simpkins-Fresno, Murad, Almasri, Gauri, Kulkarni, Hisham, Marwan, Mohammad, Mehdi, Rasaq, Olaosebikan, Camilo, Velasquez, Rodrigo, Arrangoiz, Jeronimo Garcialopez De Llano, Adrian, Legaspi, Maria Fernanda Mijares Olivo, Amit, Sastry, Vanitha, Vasudevan, Hector, Garcia-Chavez, Atif, Iqbal, Yesenia, Rojas-Khalil, Malke, Asaad, Charles, Butler, Cameron, Gaskill, Patrick, Hensley, Jose, Karam, Matthew, Katz, Huan, Nguyen, Alberto, Pieretti, Christina, L Roland, Perel, Baral, D David Beahm, German, Berbel, Andres, Bur, Shea, Carver, Austin, Findley, Christopher, A Guidry, Megan, Hedlund, Corey, Hounschell, Sean, Kumer, Kelsey, E Larson, Derek, Marlor, Madhuri, Reddy, Scott, Turner, Alissa, Urich, Alexander, Cavalea, Brian, Daley, Bailey, Humphreys, Rachel, Savoy, Mary, Leech, Andrew, Loehrer, Kari, Rosenkranz, Avi, Bhavaraju, Nolan, Bruce, Lyle, Burdine, Kyle, Kalkwarf, Mary, Kimbrough, Garrett, Klutts, Joseph, Margolick, Tamara, Osborn, Anna, Privratsky, Matthew, Roberts, Jennifer, Baker, Peyman, Benharash, Ronald, W Busuttil, Robert, B Cameron, Joseph, Dinorcia, Joseph, Hadaya, Farnaz, Haji, Lien, Hua-Feng, Catherine, Juillard, Minna, Lee, Garrett, Salzman, Gregory, Senofsky, Richard, J Shemin, Jeannie, Shen, Carlie, Thompson, Areti, Tillou, Elizabeth, Bruenderman, Samuel, Carson, Clayton, Ellis, Farid, Kehdy, Robert C, G Martin 2nd, Tyler, Mouw, Amy, Wise, Linda, Britton-Zier, Julie, Dunn, Benjamin, Massey, Chathurika Samudani Dhanasekara, Thomas, Wyatt, Daniel, Abbott, Eugene, Foley, Stephanie, Savage, Patrick, Schwartz, Syed Nabeel Zafar, Lauren, Camp, Ruth, A Lewit, Alessia, Cioci, Amber, Collier, Gareth, Gilna, Neha, Goel, Joshua, Kronenfeld, Rebecca, Saberi, Eva, Urrechaga, Juan, Figueroa, Basil, Karam, Rachel, Morris, Christopher, J LaRocca, Archana, Ramaswamy, Steven, Waisbren, Jacob, Ankeny, Rahel, Ghebre, Jane Yuet Ching Hui, Eric, Jensen, Jordan, Mattson, Rachel, Vogel, Emily, Colonna, Frederick, Endorf, Rachel, M Nygaard, Alva, Bethurum, Rohan, Bhalla, David, Bichell, Christopher, Bonfield, Silky, Chotai, Michael, Dewan, Alexander, Hawkins, Aimal, Khan, J Matthew Kynes, Alexandra, Mata, Christopher, Wallis, Camila, Walters, Alice, Wang, Irving, Zamora, Lindsey, Zamora, Marah, Maayah, Melanie, Sion, Sarah, Ullrich, Dalia, Alqunaibit, Kiah, Andrews, Danielle, Friedman, John, Mcnelis, Yasmin, Abedin, Brian, Batko, Anthony, Colon, Sofia, Gabrilovich, Carma, Goldstein, Christina, Gory, Janmejay, Hingu, Brian, Leoce, Anh, Nguyen, Guergana, Panayotova, Ruchi, Ram, Deviney, Rattigan, Jerette, Schultz, Sara, Solar, John, Stein, Grace, Tsui, Elizabeth, Warnack, Apostolos, Gaitanidis, Leon, Naar, Robert, Sinyard, Sophia, Angelides, Laura, Fitzmaurice, Alexander, Himstead, Mehraneh, Jafari, Zeljka, Jutric, Kari, Kansal, Lydia, Kirillova, Isabella, Kuo, Kapila, Patel, Erika Linmey Tay Lasso, Maki, Yamamoto, Maleeha, Ahmad, Steven, Chang, Gary Alan Bass, Benjamin, Braslow, Daniel, Dempsey, Caoimhe, Duffy, Daniel, Holena, Jonathan, Imran, John, Keogh, Cara, Lorenzi, Niels, Martin, Mark, Seamon, Lauren, Huckaby, Katrina, Morgan, Caroline, Rieser, Lauren, Rosenblum, Cindy, Teng, J Michael DiMaio, Mohanad, Hamandi, Mary, Hoffman, Allison, T Lanfear, Michael, Connolly, Benjamin, Hall, Tareq, Kheirbek, Elizabeth, Renaud, Kevin, Behm, Judy, Boughey, Kristin Cardiel Nunez, Sean, Cleary, Mihai, Dumbrava, Travis, Grotz, James, Jakub, Rahul, Kanade, David, Larson, Sherief, Shawki, Dennis, Wigle, Haradeen, Dhillon, Avni, Suri, Leonardo Weber Graeff, Ahmed, Elshabrawy, Grace Ihsiu Todd, Mark, Davies, Yan, Qi, Walter, Biffl, Kathryn, Schaffer, Sarah, Averbach, Terry, Curry, Alexandra, Schwartz, Mary Kathryn Abel, Veronica, Andaya, Kristina, Benirschke, Katherine, Bigay, Marissa, Boeck, Lee-Lynn, Chen, Lee-May, Chen, Huey-Lan, Chern, Amanda, Compadre, Patricia, Conroy, Alexa, Glencer, Patrick, Ha, Barbara Cs Hamilton, Johannes, R Kratz, Rondall, Lane, Rex, H Lee, Brenda, Nunez-Garcia, Richard, O'Donnell, Doruk, Ozgediz, Paul, Park, Ankit, Sarin, Ipsit, Shah, Bonnie, Sheu, Madhulika, Varma, Katherine, Wai, Rosanna, Wustrack, Mary Jue Xu, Melissa, Zimel, Pedro, Escobar, Meredid Maldonado Santiago, Mohammad, Azam, Asad, Choudhry, Eric, Hammond, William, Marx, Jihad, Abbas, Somya, Al-Embideen, Carol, Angel, Bailea, Bobich, Raul, Bosio, Gregory, Georgiadis, Tahir, Jamil, Maria, Kenner, Meghan, Lark, Tamara, Maghathe, Sonia, Masih, Gabriel, Naimy, Kristin, O'Mara-Gardner, Emily, Rady, Roberta, Redfern, Jack, Sample, Joseph, Sferra, Kaitlyn, Sharp, Jessica, Shoemaker, Stephen, Stanek, John, Stengle, Hibba, Sumra, Jeffrey, M Sutton, Faris, Azar, Anne, Fischer, Jaymie, Henry, Lawrence, Lottenberg, Mario, Rueda, Sasha, Thiel, Adel, Bozorgzadeh, John, Kelly, Armando Salim Munoz Abraham, Erin, Scott, Camila, Haro, Andrés, Pouy, Gastón, Acuña, Sofia, Álvarez, Ana Carmen Carbajal, Fabiola, Castedo, Diego, Pereiranuñez, Helena, Sobrero, Josefina, Tarigo, Rafat, Al-Saban, Fatima, Al-Eryani, Siham Al Maqtari, Sahar, Al-Maqtari, Mahmmoud, Abdualqader, Majed, Aeed, Ghadeer Al Sanany, Anwaar Al Dhafif, Buthina Al Jarmozi, Saba, Al-Ameri, Awsan, Al-Dhaheri, Dhyia Alhuq Al-Surimi, Amira, Alakhdury, Sabreen, Alashmali, Zainab, Alattas, Manar, Alduba'Ai, Hamdan, Aldumaini, Wafa, Alhaddad, Abdelrahman, Alharazi, Nawal, Alhemyari, Adnan, Alhumaida, Maniee, Aljabri, Hassan, Almarashi, Zuhoor, Almohanady, Marwa, Alodine, Nooraldin, Alqasemi, Basma, Alqudaimi, Ansam Mohammed Ghaleb Alrobaiee, Mohammed, Alsabri, Radfan, Alsalal, Ramzi, Alsayadi, Musaed, Alsayadi, Reem, Alshaipani, Ebrahim, Alsharabi, Nora, Atiah, Hadeel, Bajjah, Muhib, Esmael, Asma, Ghallab, Rana, Ghannam, Adwa'A, Hamid, Lina, Hashem, Sara, Saif, Shaima, Sayad, Nawras, Shaban, Amatallah Hadi Shamsan, Sarah, Shream, Amal, Shukri, Shahd, Zeid, Nabila, Abdullah, Abdulrahman Faisal Al-Garadi, Ahmed, M Ali Al-Radhi, Norhan, Naji, Shaima'A, Nasser, Areej Taha Al Anaib, Ebrahim, Abdurab, Fadhl Al Muhtadi, Amer, Al-Hebbah, Ahmed, Al-Madhrahi, Shehab, Al-Mahdi, Sakhr Abdulhakeem Al-Maswari, Ayman, Al-Oqabi, Zakarya Abdullah Al-Zaazaai, Karim, Al-Zazay, Ali, Alafif, Asem, Albzzaz, Lina, Alqalisi, Mohammed, Alrezami, Haneen, Alshargabi, Mokhtar, Alshargabi, Hossam, Ghanem, Kareem, Saeed, Rasheed, Shalabi, Fareed, Showqi, Miriam, Maimbo, Catherine, Mkandawire, Mulaya, Mubambe, Theresa, Nkole, Vanessa, Savopoulos, Patricia, Shinondo, Chabwera, Shumba, Penias, Tembo, Shelton, Chivanga, Ngqabutho, Dube, Handsome, Dube, Daniel, Dzinotyiwei, Ronald, Makanda, Moses, Mangena, Partson, Maphosa, Derek, Matsika, Proud, Mawere, Nkosikhona, Moyo, Assel, Moyo, Arnold, Muguwu, Simbarashe, Mungazi, Garikai, Mwale, Gamuchirai, Ndabvonga, Mambote Crispin Olivier Ntoto, Hardlife, Ranganai, Ernesto Sánchez Castillo, Oltah, Tshuma, Grace, Gwini, Vimbai Moyana Muguto, Gilbert, Moyo, Trust, Mushawarima, Tinashe, Shoko, Rorisang, Jamela, Marvellous, Machiri, Eric, Shumba, Antony, Chengahomwe, Yemurai, Bikwa, Maxwell, Chimhina, Jeremy, Marume, Kudzayi, Munanzvi, Precious G, T Mutambanengwe, Federico, Ferrari, Marco, Fontanella, Franco, Odicino, Romano, Vito, Nepogodiev D, Emanuele Cammarata, Sofia Campanella, Daniela Canzonieri, Adriana Cordova, Federico De Michele, Ettore Dinoto, Mara Franza, Leo Licari, Daniele Matta, Domenico Mirabella, Felice Pecoraro, Roberto Pirrello, Pierfrancesco Pugliese, Fernando Rosatti, Giuseppe Salamone, Francesca Toia, Massimiliano Tripoli, Nepogodiev, D, Rosati, R, Surgery, Medicine and Pharmacy academic/administration, Basic (bio-) Medical Sciences, Surgical clinical sciences, Faculty of Medicine and Pharmacy, Gastroenterology, Medical Oncology, Clinical sciences, Breda, João, ARD - Amsterdam Reproduction and Development, Paediatric Surgery, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, AGEM - Endocrinology, metabolism and nutrition, Graduate School, Tytgat Institute for Liver and Intestinal Research, Laura Alberici, Filippo Antonacci, Alessandro Arena, Angela Belvedere, Fabio Bernagozzi, Paolo Bernante, Pietro Bertoglio, Lorenzo Bianchi, Maria Bisulli, Barbara Bonfanti, Safia Boussedra, Jury Brandolini, Crescenzo Cacciapuoti, Stefano Cardelli, Riccardo Casadei, Matteo Cescon, Alessandro Cipolli, Riccardo Cipriani, Alfredo Conti, Luca Contu, Francesco Costa, Niccolo’ Daddi, Eugenia De Crescenzo, Pierandrea De Iaco, Alessandra De Palma, Massimo Del Gaudio, Anna Nunzia Della Gatta, Giampiero Dolci, Giulia Dondi, Matteo Droghetti, Sergio Nicola Forti Parri, Elena Garelli, Chiara Gelati, Giuliana Germinario, Federico A. Giorgini, Carlo Ingaldi, Elio Jovine, Kenji Kawamukai, Antonio Lanci Lanci, Raffaele Lombardi, Maria Elisa Lozano Miralles, Claudio Marchetti, Michele Masetti, Francesco Minni, Daniele Morezzi, Daniele Parlanti, Alice Pellegrini, Anna Myriam Perrone, Anna paola Pezzuto, Marco Pignatti, Gianluigi Pilu, Valentina Pinto, Gilberto Poggioli, Silvana Bernadetta Puglisi, Diego Raimondo, Matteo Ravaioli, Claudio Ricci, Sara Ricciardi, Francesco Ricotta, Roberta Rizzo, Angela Romano, Matteo Rottoli, Riccardo Schiavina, Renato Seracchioli, Matteo Serenari, Margherita Serra, Piergiorgio Solli, Gioia Sorbi, Mario Taffurelli, Marta Tanzanu, Achille Tarsitano, Marco Tesei, Gabriele Vago, Tommaso Violante, Simone Zanotti, Tommaso Frisoni, leonardo solaini, giorgio ercolani, Fruscio, R, Ornaghi, S, Collaborative, Covidsurg, Collaborative, Globalsurg, Palmisano, Silvia, de Manzini, Nicolo', Žundienė, Laura, Dulskas, Audrius, Kuliavas, Justas, Čekauskas, Albertas, Kielaitė-Gulla, Aistė, Poškus, Tomas, Strupas, Kęstutis, Želvys, Arūnas, COVIDSurg Collaborative, GlobalSurg Collaborative, Department of Surgery, HUS Abdominal Center, Simoes, Jff, Li, E, Picciochi, M, Glasbey, Jc, Baiocchi, G, Blanco-Colino, R, Chaudhry, D, Alameer, E, El-Boghdadly, K, Wuraola, F, Ghosh, D, Gujjuri, Rr, Harrison, Em, Lule, H, Kaafarani, H, Khosravi, M, Kronberger, I, Leventoglu, S, Mann, H, Mclean, Ka, Mengistu, Gm, Modolo, Mm, Ntirenganya, F, Norman, L, Outani, O, Pius, R, Pockney, P, Qureshi, Au, Roslani, Ac, Satoi, S, Shaw, C, Bhangu, A, Omar, Om, Ahmed, Wur, Argus, L, Ball, A, Bywater, Ep, Brar, A, Dawson, Be, Duran, I, Elhadi, M, Jones, C, Kamarajah, Sk, Keatley, Jm, Lawday, S, Marson, Ej, Ots, R, Santos, I, Taylor, Eh, Trout, Im, Varghese, C, Venn, Ml, Xu, W, Dajti, I, Gjata, A, Kacimi, Seo, Boccalatte, L, Cox, D, Townend, P, Aigner, F, Kronberger, Ie, Samadov, E, Alderazi, A, Hossain, K, Padmore, G, van Ramshorst, G, Lawani, I, Cerovac, A, Delibegovic, S, Gomes, Gma, Buarque, Il, Gohar, M, Slavchev, M, Nwegbu, C, Agarwal, A, Martin, J, Ng-Kamstra, J, Olivos, M, Lou, Wh, Ren, Dl, Calvache, Ja, Rivera, Cjp, Hadzibegovic, Ad, Kopjar, T, Mihanovic, J, Jimenez, Pma, Gouvas, N, Klat, J, Novysedlak, R, Amisi, N, Christensen, P, El-Hussuna, A, Batista, S, Lincango-Naranjo, E, Emile, S, Sandoval, Daa, Dhufera, H, Hailu, S, Mengesha, Mg, Kauppila, Jh, Arnaud, Ap, Demetrashvili, Z, Albertsmeier, M, Lederhuber, H, Loffler, Mw, Acquah, Dk, Ofori, B, Tabiri, S, Metallidis, S, Tsoulfas, G, Aguilera-Arevalo, Ml, Recinos, G, Mersich, T, Wettstein, D, Kembuan, G, Milan, Pb, Khosravi, Mh, Mozafari, M, Hilmi, A, Mohan, H, Zmora, O, Gallo, G, Pata, F, Pellino, G, Fujimoto, Y, Kuroda, N, Abou Chaar, Mk, Ayasra, F, Fakhradiyev, I, Hamdun, Ih, Jin-Young, J, Jamal, M, Karout, L, Gulla, A, Rasoaherinomenjanahary, F, Samison, Lh, Sanchez, Iid, Gonzalez, D, Martinez, L, Martinez, Mj, Nayen, A, and Ramos-De la Medina, A
Subjects: Male, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], MULTICENTER, infectious diseases, 0302 clinical medicine, 030202 anesthesiology, Anesthesiology, Cirugía, 80 and over, Prospective Studies, Young adult, Child, Lung, Aged, 80 and over, COVID-19, delay, SARS-CoV-2, surgery, timing, SARS‐CoV‐2 infection, Operative, Child, Preschool, Pneumonia & Influenza, Infection, Cohort study, Human, medicine.medical_specialty, Clinical Sciences, Sars-cov-2, GlobalSurg Collaborative, Settore MED/28 - MALATTIE ODONTOSTOMATOLOGICHE, 03 medical and health sciences, Clinical Research, Biodefense, Correspondence, Humans, PULMONARY COMPLICATIONS, CRIANÇAS EM IDADE PRÉ-ESCOLAR, Aged, Science & Technology, Cirurgia, Prevention, Infant, Odds ratio, Pneumonia, Prospective Studie, Clinical research, Surgery, Human medicine, 610 Medizin und Gesundheit, 1109 Neurosciences, Internationality, Settore MED/29 - CHIRURGIA MAXILLOFACCIALE, Settore MED/18 - CHIRURGIA GENERALE, Adolescent, Adult, Cohort Studies, Female, Middle Aged, Surgical Procedures, Operative, Time, Young Adult, Practice Guidelines as Topic, gastroenterology, Medicine and Health Sciences, 030212 general & internal medicine, Prospective cohort study, Mortality rate, Covid19, Infectious Diseases, Patient Safety, medicine.symptom, 6.4 Surgery, Life Sciences & Biomedicine, 610 Medicine & health, COVID-19, SARS-CoV-2, delay, surgery, timing, Asymptomatic, NO, COVIDSurg Collaborative, Vaccine Related, All institutes and research themes of the Radboud University Medical Center, medicine, Mortalitat, ddc:610, Mortality, Preschool, LS7_4, Surgical Procedures, business.industry, Neurosciences, Evaluation of treatments and therapeutic interventions, 1103 Clinical Sciences, 3126 Surgery, anesthesiology, intensive care, radiology, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Anesthesiology and Pain Medicine, Emerging Infectious Diseases, Good Health and Well Being, Mortalidad, Cohort Studie, business
Abstract: Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay. ispartof: ANAESTHESIA vol:76 issue:6 pages:748-758 ispartof: location:England status: published
Published: 2021

36. Outcomes of off-the-shelf multi-branched stent grafts with intentional occlusion of directional branches using endovascular plugs during endovascular repair of complex aortic aneurysms

Author: Gustavo S. Oderich, Ahmed Eleshra, Mauro Gargiulo, Emanuel R. Tenorio, Bijan Modarai, Guilherme B.B. Lima, Tilo Kölbel, Roberto Chiesa, Luca Bertoglio, Carlos H. Timaran, Carla K. Scott, Tomasz Jakimowicz, Katarzyna Jama, Tenorio, E. R., Oderich, G. S., Kolbel, T., Gargiulo, M., Timaran, C. H., Bertoglio, L., Modarai, B., Jama, K., Eleshra, A., Lima, G. B. B., Scott, C., Chiesa, R., and Jakimowicz, T.
Subjects: Male, medicine.medical_specialty, Time Factors, Endoleak, medicine.medical_treatment, t-branch, Balloon, Prosthesis Design, Blood Vessel Prosthesis Implantation, Aneurysm, Postoperative Complications, Risk Factors, Occlusion, medicine, Humans, Myocardial infarction, Dialysis, Aged, Retrospective Studies, Complex aortic aneurysms, Aortic Aneurysm, Thoracic, business.industry, Endovascular Procedures, Stent, Branched endovascular aortic repair, Thoracoabdominal aortic aneurysm, Vascular plug, medicine.disease, Surgery, Aortic Aneurysm, Blood Vessel Prosthesis, medicine.anatomical_structure, Treatment Outcome, Female, Stents, Cardiology and Cardiovascular Medicine, Paraplegia, business, Artery
Abstract: Objective: To evaluate the technique and outcomes of intentional occlusion of directional branches (DBs) using endovascular plugs during branched endovascular aortic repair using off-the-shelf Zenith t-Branch thoracoabdominal (TAAA) stent grafts. Methods: We reviewed the clinical data and outcomes of all consecutive patients treated by branched endovascular aortic repair using off-the-shelf Zenith t-Branch TAAA stent-graft (Cook Medical, Bloomington, Ind) in seven academic centers from 2013 to 2019. All patients had at least one DB intentionally occluded using extension of the branch with balloon or self-expandable covered stent, followed by placement of endovascular plugs. Intentional occlusion was indicated in patients with variations in the normal four-vessel renal-mesenteric anatomy, pre-existing dialysis, or in those who failed catheterization of a target vessel. End points were 30-day/in-hospital mortality, major adverse events, secondary interventions, target artery (TA) patency, TA instability, and patient survival. Results: There were 100 patients, 65 male and 35 female, with median age of 71 years (interquartile range [IQR], 66-75 years). Of these, 31 patients (31%) had urgent/emergent operations for symptomatic/contained ruptured aneurysms. The median aneurysm diameter was 72 mm (IQR, 61-85 mm). A total of 290 renal-mesenteric arteries were incorporated with a median of three (IQR, 3-3) vessels/patient. Indications for DB occlusion were less than four suitable renal-mesenteric targets in 84 patients or pre-existing dialysis and inability to catheterize a target vessel in eight patients each. There were 110 DBs occluded by vascular plugs, including 48 celiac axis, one superior mesenteric artery, and 61 renal DBs. Thirty-day/in-hospital mortality was 10%, including 9% for elective and 13% for urgent/emergent procedures. Major adverse events occurred in 44 patients (44%), including acute kidney injury in 19 patients (19%), estimated blood loss >1 L in 12 patients (12%), respiratory failure and new onset dialysis in six patients (6%) each, bowel ischemia in five patients (5%), and myocardial infarction and paraplegia in two patients (2%) each. The median follow-up was 5 months (range, 1-13 months). Eighteen patients (18%) required secondary interventions, none for problems related to the occluded DB. There were no endoleaks related to the occluded DB. At 2 years, primary and secondary patency and freedom from TA instability were 93% ± 3%, 97% ± 2%, and 91% ± 4%, respectively. Freedom from secondary interventions and patient survival were 75% ± 6% and 63% ± 7%, respectively. Conclusion: Intentional occlusion of DBs using endovascular plugs allows versatile use of a four-vessel off-the-shelf multi-branched TAAA stent graft in patients with variations in the normal renal and mesenteric anatomy or when technical difficulties prevent successful target vessel stenting. There were no endoleaks or secondary interventions associated with the occluded DB.
Published: 2021

37. Open or endovascular treatment of downstream thoracic or thoraco-abdominal aortic pathology after frozen elephant trunk: perioperative and mid-term outcomes

Author: Germano Melissano, Alessandro Grandi, Roberto Chiesa, Domenico Baccellieri, Luca Bertoglio, Fabrizio Monaco, Diletta Loschi, Andrea Melloni, Loschi, Diletta, Melloni, Andrea, Grandi, Alessandro, Baccellieri, Domenico, Monaco, Fabrizio, Melissano, Germano, Chiesa, Roberto, and Bertoglio, Luca
Subjects: Pulmonary and Respiratory Medicine, Aortic arch, Male, Pathology, medicine.medical_specialty, Elephant trunks, Candy plug, Chronic aortic dissection, Fenestrated-branched endovascular aortic repair, Frozen elephant trunk, Thoraco-abdominal aortic aneurysm, Blood Vessel Prosthesis Implantation, Postoperative Complications, Interquartile range, medicine.artery, medicine, Humans, Adverse effect, Retrospective Studies, Aortic Aneurysm, Thoracic, business.industry, Endovascular Procedures, General Medicine, Perioperative, Vascular surgery, Middle Aged, medicine.disease, Blood Vessel Prosthesis, Treatment Outcome, Cohort, Surgery, Cardiology and Cardiovascular Medicine, Paraplegia, business
Abstract: OBJECTIVES The aim of this study was to evaluate the outcomes of open and endovascular treatment of downstream thoracic or thoraco-abdominal aortic pathology in patients who underwent previous frozen elephant trunk (FET). METHODS Data were retrieved to evaluate mortality, cardiac, pulmonary, cerebrovascular, renal and spinal cord major adverse events, early- and mid-term reintervention and survival rates. The Society for Vascular Surgery endovascular reporting standards were used. RESULTS From 2011 to 2020, 48 patients (36 males, median age 60 years) underwent downstream aortic repair at a median of 18 months (interquartile range: 6–57) after the initial FET. Twenty-eight patients (58.3%) received open and 20 (41.7%) endovascular repair. The overall 30-day mortality was 6.3% and the initial clinical success was 88%, with no inter-group differences (P = 0.22 and 0.66 respectively). Six spinal cord deficits were recorded (13%): 3 (6.3%) were permanent. The major adverse events incidence was lower in the endovascular cohort [4 (20%) vs 14 (50%); P = 0.047], mainly due to a lower rate of grade ≥2 respiratory complications (5% vs 42.9%; P = 0.004). Assisted primary clinical success at 5 years was higher in the endovascular group (95% vs 68%, P = 0.022); freedom from reintervention at competing risk analysis (P = 0.3) and overall survival at Kaplan–Meier curves (log-rank P = 0.29) were similar. CONCLUSIONS Downstream aortic repair after FET is feasible with both open and endovascular repair with acceptable mortality and permanent paraplegia rates. The endovascular approach has potential perioperative and mid-term advantages, but long-term durability has to be further investigated in larger cohorts.
Published: 2021

38. Late Open Conversion Following Failure of EVAR and TEVAR: 'State of the Art'

Author: Niccolò Carta, Luca Bertoglio, Roberto Chiesa, Enrico Rinaldi, Andrea Kahlberg, Daniele Mascia, Rinaldi, E., Kahlberg, A., Carta, N., Mascia, D., Bertoglio, L., and Chiesa, R.
Subjects: Reoperation, medicine.medical_specialty, Complications, Endoleak, medicine.medical_treatment, Endovascular, EVAR, Open conversion, TEVAR, Endovascular aneurysm repair, 030218 nuclear medicine & medical imaging, Blood Vessel Prosthesis Implantation, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, Aorta, Aortic Aneurysm, Thoracic, business.industry, Incidence (epidemiology), Mortality rate, Endovascular Procedures, Aortic surgery, Surgery, Thoracic area, Open repair, Stents, Cardiology and Cardiovascular Medicine, business, Aortic Aneurysm, Abdominal
Abstract: Abdominal endovascular aneurysm repair (EVAR) and thoracic endovascular aneurysm repair (TEVAR) have changed the aortic surgery, due to several advantages in terms of reduced morbidity and mortality. However, increasing rate of late complications requiring secondary procedures has been observed over time. Even if the majority of them may be treated by means of endovascular techniques, late open surgical conversion (LOSC) is required in specific situations. This paper aims to provide our single-center experience with LOSCs and an updated review of the literature. From 1995 to 2020, indications and outcomes of patients treated with LOSC for failed EVAR and TEVAR, at our institutions, were analyzed. LOSC was required to treat a broad range of complications that were classified into two main groups: "disease related" and "stent-graft (SG) related." Among the 121 patients treated with LOSC after EVAR, endoleak (75.2%) represented the most common indication. The overall 30-day mortality rate was 3.3%. A higher mortality rate was associated with infection after EVAR (p. 006). Among the 81 patients treated with LOSC after TEVAR, endoleak (32.1%) was the most common indication. The overall 30-day mortality rate was 13.6% with a higher incidence in the SG-related group (p. 02). LOSC is associated with an increased surgical complexity, in both the abdominal and thoracic area, that results in higher morbidity and mortality rates compared with standard open repair. Depending on the indication to LOSC, specific surgical maneuvers are required to improve clinical outcomes.
Published: 2020

39. Bridging INTERMACS 1 patients from VA-ECMO to LVAD via Impella 5.0: De-escalate and ambulate

Author: Benedikt Schrage, Hermann Reichenspurner, Letizia Bertoldi, Alexander M. Bernhardt, Meike Rybczinski, Markus J. Barten, Edith Lubos, Elisabetta Lapenna, Federico Pappalardo, Dirk Westermann, Tim Legros, Luca Bertoglio, Hanno Grahn, Bertoldi, L. F., Pappalardo, F., Lubos, E., Grahn, H., Rybczinski, M., Barten, M. J., Legros, T., Bertoglio, L., Schrage, B., Westermann, D., Lapenna, E., Reichenspurner, H., and Bernhardt, A. M.
Subjects: Inotrope, medicine.medical_specialty, medicine.medical_treatment, Hemodynamics, Left ventricular assist device, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Extracorporeal membrane oxygenation, medicine, Cardiogenic shock, Impella, Ventricular function, Early weaning, business.industry, 030208 emergency & critical care medicine, medicine.disease, Surgery, surgical procedures, operative, 030228 respiratory system, Right ventricular failure, Veno-arterial extracorporeal membrane oxygenation, Impella 5.0, business
Abstract: Purpose Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) stabilizes patients in refractory cardiogenic shock. However, ECMO-related complications strongly affect the outcome, especially if a long-term LVAD is needed. Methods and materials We describe a new strategy in management of INTERMACS 1 patients consisting in early weaning from VA-ECMO with axillary Impella 5.0 as a bridge to LVAD implantation. Nine patients in two European centres are described. Results All patients were implanted with VA-ECMO for initial hemodynamic and metabolic stabilization. After a median time of 8 days, Impella 5.0 was implanted. Impella support allowed in all patients weaning from inotropes and from VA-ECMO (after a median time of 22 h). No patients had right ventricular failure after ECMO-weaning and most patients were mobilized and orally fed (88.9%) during Impella support. All patient underwent LVAD implantation after a median Impella time of 17 days. Only one patient had right-ventricular failure after LVAD implantation. All patients were discharged from hospital after a median time of 40 days. Conclusion Early weaning from VA-ECMO with Impella 5.0 as a bridge to LVAD is a safe and effective strategy in management of INTERMACS 1 patients. This approach minimizes ECMO-related complications and allows patient mobilization and right ventricular function optimization before LVAD implantation.
Published: 2020

40. Steerable Sheath for Cannulation and Bridging Stenting of Challenging Target Visceral Vessels in Fenestrated and Branched Endografting

Author: Enrico Gallitto, Giacomo Isernia, Mauro Gargiulo, Luca Bertoglio, Giovanni Pratesi, Roberto Chiesa, Arnaldo Ippoliti, Massimo Lenti, Gianluca Faggioli, Martina Goretti, Gallitto E., Faggioli G., Bertoglio L., Pratesi G., Isernia G., Goretti M., Ippoliti A., Lenti M., Chiesa R., Gargiulo M., Gallitto, E, Faggioli, G, Bertoglio, L, Pratesi, G, Isernia, G, Goretti, M, Ippoliti, A, Lenti, M, Chiesa, R, and Gargiulo, M.
Subjects: Male, Time Factors, Databases, Factual, medicine.medical_treatment, Thoracic, Technical success, Cannulation, 030204 cardiovascular system & hematology, Thoracoabdominal Aortic Aneurysms, Endovascular aneurysm repair, 030218 nuclear medicine & medical imaging, 0302 clinical medicine, Postoperative Complications, Interquartile range, Fenestrated Endograft, Occlusion, Registries, AAA, Aortic Aneurysm, Abdominal, Aortic Aneurysm, Thoracic, Blood Vessel Prosthesis Implantation, Endovascular Procedures, Female, Humans, Italy, Prosthesis Design, Retrospective Studies, Treatment Outcome, Vascular Patency, Blood Vessel Prosthesis, Stents, Vascular Access Devices, Bridging Stenting, Visceral Vessels, General Medicine, Aortic Aneurysm, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Bowel ischemia, 03 medical and health sciences, Databases, medicine, Abdominal, Factual, business.industry, Branched endograft, Surgery, Settore MED/22, Visceral vessels, Steerable Sheath,Cannulation andBridging Stenting, Challenging TargetVisceral Vessels, Fenestrated and BranchedEndografting, Cannulation, Bridging Stenting, Visceral Vessels, Fenestrated Endograft, Branched endograft, AAA, business
Abstract: Background To report the use of the Oscor Destino steerable sheath in challenging target visceral vessel (TVV) cannulation/bridging stenting in fenestrated and branched endovascular aneurysm repair (FB-EVAR). Methods Between 2016 and 2018, patients undergoing FB-EVAR for juxtarenal/pararenal aneurysms (j/p-AAAs) and thoracoabdominal aortic aneurysms (TAAAs) were recorded. Cases requiring the use of the steerable sheath as planned or unplanned maneuvers were analyzed. Technical success, freedom from reinterventions, and TVV patency were assessed. Results Two hundred sixty patients underwent FB-EVAR to treat j/p-AAAs and TAAAs, for an overall of 956 TVVs. Among these, the Oscor Destino steerable sheath was used in 33 (13%) cases to cannulate a total of 62 (7%) TVVs. FB-EVAR was performed for 7 (21%) j-AAAs, 4 (12%) p-AAAs, 11 (61%) TAAAs, and 2 (6%) previously failed EVAR. The TVVs were 37 (60%) renal arteries, 9 (15%) superior mesenteric arteries, and 16 (25%) celiac trunks. The Oscor Destino steerable sheath was used as the primary cannulation approach in 29 (47%) cases and after failure of the standard cannulation technique in 33 (53%) cases. Technical success was achieved in 61/62 (98%) TVVs. There was no 30-day mortality or bowel ischemia. At the discharge, there were no type I/III endoleaks, whereas 4 type II endoleaks were detected. The median follow-up was 12 months (interquartile range: 8). One patient died at 6 months because of aneurysm-unrelated cause. No TVV occlusion or TVV-related reinterventions occurred. There were no type I–III endoleaks. Conclusions The use of the steerable sheath could be an effective adjunctive tool and can be used primarily as a planned technique or in case of failure of the standard cannulation technique in challenging TVV anatomy during FB-EVAR.
Published: 2020

41. A Modified Proximal Stent-Graft for Spinal Cord Preconditioning During Staged Endovascular Repair of Thoracoabdominal Aortic Aneurysms

Author: Niccolò Carta, Roberto Chiesa, Germano Melissano, Luca Bertoglio, Enrico Rinaldi, Rinaldi, E., Carta, N., Melissano, G., Chiesa, R., and Bertoglio, L.
Subjects: Male, medicine.medical_specialty, spinal cord ischemia, Time Factors, medicine.medical_treatment, spinal cord preconditioning, Thoracic, Thoracoabdominal Aortic Aneurysms, Prosthesis Design, Seal (mechanical), custom-made device, Blood Vessel Prosthesis Implantation, Risk Factors, medicine.artery, thoracoabdominal repairs, medicine, Humans, Radiology, Nuclear Medicine and imaging, endovascular aortic repair, Aged, Aortic Aneurysm, Thoracic, business.industry, Endovascular Procedures, Stent, Spinal cord ischemia, Spinal cord, Surgery, Aortic wall, Aortic Aneurysm, Blood Vessel Prosthesis, surgical procedures, operative, medicine.anatomical_structure, Treatment Outcome, Spinal Cord, Regional Blood Flow, fenestrated/branched stent-graft, Female, Stents, intercostal arteries, Cardiology and Cardiovascular Medicine, business, Intercostal arteries, Spinal Cord Ischemia
Abstract: Purpose: To describe a new custom-made thoracic device able to seal against the aortic wall and occlude intercostal arteries for spinal cord preconditioning during the first thoracic stage of a thoracoabdominal endovascular repair. Technique: The custom-made device, based on the Zenith Alpha stent-graft, combines different features from 2 previously described devices: the outer part is designed with a bell-bottom configuration similar to the “Embo” stent-graft, while the inner part mimics the “2 in 1” design. The outer stent-graft is designed to span the entire length of the thoracic aorta and cover as many intercostal arteries as possible during the first stage to effectively precondition the spinal cord. The sutured inner component is customizable in diameter and 20 to 40 mm shorter than the outer stent-graft. The technique has been used in 5 patients. Conclusion: The use of this new custom-made thoracic stent-graft might represent an additional tool for effectively preconditioning the spinal cord during fenestrated and branched staged procedures whenever a proximal thoracic proximal component is needed.
Published: 2020

42. The revascularization technique does not impact renal function after proximal abdominal aortic aneurysm open repair

Author: Concetta Saracino, Germano Melissano, Andrea Kahlberg, Alessandro Grandi, Roberto Chiesa, Daniele Mascia, Luca Bertoglio, Mascia, Daniele, Grandi, Alessandro, Bertoglio, Luca, Kahlberg, Andrea, Saracino, Concetta, Melissano, Germano, and Chiesa, Roberto
Subjects: Male, medicine.medical_specialty, Time Factors, Databases, Factual, medicine.medical_treatment, Renal function, 030204 cardiovascular system & hematology, Anastomosis, Kidney, Revascularization, Risk Assessment, Blood Vessel Prosthesis Implantation, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, medicine, Humans, Aged, Retrospective Studies, business.industry, Incidence (epidemiology), Endovascular Procedures, Acute kidney injury, General Medicine, Perioperative, Acute Kidney Injury, medicine.disease, Abdominal aortic aneurysm, Surgery, Treatment Outcome, 030228 respiratory system, Female, Cardiology and Cardiovascular Medicine, business, Perfusion, Aortic Aneurysm, Abdominal, Glomerular Filtration Rate
Abstract: Background To report the postoperative renal function stratified according to the visceral vessels (VV) revascularization technique used during proximal abdominal aortic aneurisms (p-AAA) open surgical repair (OR). Methods Data from all patients with p-AAA who were submitted to OR between 2010 and 2015 at our Institute were prospectively collected and analyzed. A postoperative deterioration of the estimated glomerular filtration rate (eGFR) by 25% within four days was defined as acute kidney injury (AKI) 1. Only AKI 2 (50% decrease in eGFR) and AKI 3 (75% decrease in eGFR) were considered significant for renal impairment after the procedure. Primary study end point was defined as the presence of AKI 2 or 3. Secondary end points were 30-day mortality and/or any major adverse event. Results During the study period, 157 consecutive patients (145 men and 12 women; mean age: 72±7 years) were treated. Sixty (38,2%) were cross-clamped supraceliac, 53 (33,8%) were cross-clamped suprarenal and 44 (28%) were cross- clamped inter/infrarenal. Vessel reattachment was not needed in 104 cases (66.2%). A beveled aortic anastomosis was performed in 10 (6.4%) patients, a beveled anastomosis and left renal artery (LRA) direct revascularization in 10 (6.4%), Crawford inclusion technique in 11 (7%), Crawford inclusion technique and LRA direct revascularization in six (3.8%) and direct revascularization of one or more renal arteries in 16 (10.2%). Peri-operative mortality was 1.9%. An increased incidence of AKI 2 and AKI 3 was observed in patients undergoing revascularization of all VV with LRA separate revascularization: in particular 40% of of beveled proximal anastomosis (p=0.001) and in 16.7 of Crawford inclusion technique (p=0.025) respectively. On the other hand, those patients who did not require any VV revascularization had a decreased incidence of AKI>1 (p=0.010). The follow-up data of 63.6±21 months shows no significant difference in renal function according to the revascularization technique used compared to the perioperative period. Conclusions Postoperative renal failure after p-AAAs repair is still a major concern although perfusion techniques and organ protection are important to reduce its frequency. Despite recent development of complex endovascular techniques, OR, when offered in high-volume centers, remains safe, effective and durable.
Published: 2020

43. Pattern of vascular disease in Lombardy, Italy, during the first month of the COVID-19 outbreak

Author: Daniele Mascia, Luca Bertoglio, Roberto Chiesa, Enrico Rinaldi, Domenico Baccellieri, Germano Melissano, Andrea Kahlberg, Melissano, G., Mascia, D., Baccellieri, D., Kahlberg, A., Bertoglio, L., Rinaldi, E., and Chiesa, R.
Subjects: Male, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Age Factors, Aged, 80 and over, Betacoronavirus, Coronavirus Infections, Elective Surgical Procedures, Emergencies, Emergency Treatment, Female, Humans, Incidence, Infection Control, Italy, Middle Aged, Pandemics, Pneumonia, Viral, Regional Health Planning, Vascular Diseases, Vascular Surgical Procedures, Pneumonia, Viral, Viral transmission, medicine, Aged, 80 and over, Vascular disease, business.industry, Viral Epidemiology, SARS-CoV-2, Incidence (epidemiology), Outbreak, COVID-19, medicine.disease, Virology, Surgery, business, Cardiology and Cardiovascular Medicine
Published: 2020

44. Frozen elephant trunk: debranch first technique

Author: Luca Bertoglio, Alessandro Verzini, Igor Belluschi, Paola Redaelli, Alessandro Castiglioni, Roberto Chiesa, Redaelli, Paola, Belluschi, Igor, Bertoglio, Luca, Verzini, Alessandro, Chiesa, Roberto, and Castiglioni, Alessandro
Subjects: Elephant trunks, business.industry, Masters of Cardiothoracic Surgery, MEDLINE, Materials Chemistry, Medicine, Surgery, Anatomy, Cardiology and Cardiovascular Medicine, business
Published: 2020

45. Commentary on 'The Italian Multicentre Registry of Fenestrated Anaconda™ Endografts for Complex Abdominal Aortic Aneurysm Repair'

Author: Roberto Chiesa, Luca Bertoglio, Bertoglio, L., and Chiesa, R.
Subjects: medicine.medical_specialty, biology, business.industry, medicine.disease, biology.organism_classification, Abdominal aortic aneurysm, Surgery, Anaconda, Blood Vessel Prosthesis Implantation, Aortic aneurysm, Italy, Humans, Medicine, Stents, Registries, Cardiology and Cardiovascular Medicine, business, Aortic Aneurysm, Abdominal, Abdominal surgery
Published: 2020

46. First experience with a ROTEM-enhanced transfusion algorithm in patients undergoing aortic arch replacement with frozen elephant trunk technique. A theranostic approach to patient blood management

Author: Monica De Luca, Annalisa Franco, Luca Bertoglio, Fabrizio Monaco, Alberto Zangrillo, Giuseppe Denaro, Pasquale Nardelli, Alessandro Castiglioni, Monaco, F., Nardelli, P., Denaro, G., De Luca, M., Franco, A., Bertoglio, L., Castiglioni, A., and Zangrillo, A.
Subjects: medicine.medical_specialty, Blood transfusion, Blood management, medicine.medical_treatment, Aorta, Thoracic, Hemostatic agents, 03 medical and health sciences, Blood Vessel Prosthesis Implantation, 0302 clinical medicine, 030202 anesthesiology, medicine, Coagulation testing, Humans, Platelet, Blood Transfusion, 030212 general & internal medicine, Precision Medicine, Frozen elephant trunk, Retrospective Studies, ROTEM, Viscoelastic tests, business.industry, Transfusion, Retrospective cohort study, Cardiac surgery, Thrombelastography, Thromboelastometry, Anesthesiology and Pain Medicine, Anesthesia, Fresh frozen plasma, business, Algorithm, Algorithms
Abstract: Study objective To assess the effect of a rotational thromboelastometry (ROTEM)-enhanced transfusion algorithm with hemostatic agents on allogenic blood transfusion in patients undergoing frozen elephant trunk (FET) surgery. Design Retrospective observational study conducted in a tertiary-care center. Setting A tertiary care referral center for cardiac surgery. Patients All patients undergoing elective FET were included in the study. Intervention Until 2016, a protocol based on estimated blood losses and conventional coagulation tests was used. After, a ROTEM-enhanced transfusion protocol was adopted. Measurements The transfusion rate of each blood component was observed and reported. Methods Retrospective, observational study. Main results Out of 40 consecutive patients, 19 underwent FET surgery with a conventional transfusion approach and 21 with a ROTEM-enhanced transfusion strategy. Considering the overall transfusion rate, the administration of fresh frozen plasma and platelets was significantly lower in the ROTEM compared to conventional group (1000 [0–2500] vs 0 [0–875] ml, p = 0.015 and 1 [1, 2] vs 0 [0–1], p = 0.016, respectively). ROTEM algorithm allowed to decrease the number of patients who required plasma and platelets transfusion of 31%. Furthermore, a 40% reduction in overall allogenic blood products was observed. Number of red blood cells administered, percentage of patients transfused with red blood cells, blood losses, reoperation for bleeding and mortality did not significantly differ between the two groups. At the multiple linear regression analysis only ROTEM algorithm was associated with a significant decrease in the number of plasma and platelets units administered intraoperatively, at 24 h, at the ICU discharge and overall. ROTEM algorithm allowed to save 1435 ml of plasma, 0.91 unit of platelets and overall transfusion cost of the 21% per patient. Conclusions A ROTEM-enhanced transfusion strategy halved intraoperative transfusion in the setting of FET. Further studies are needed to confirm the magnitude of our findings on clinically relevant endpoints.
Published: 2020

47. Anatomic feasibility of the investigational GORE EXCLUDER Thoracoabdominal Branch Endoprosthesis (TAMBE), off-the-shelf multibranched endograft for the treatment of pararenal and thoracoabdominal aortic aneurysms

Author: Luca Bertoglio, Victor Bilman, Germano Melissano, Alessandro Grandi, Tommaso Cambiaghi, Roberto Chiesa, Cambiaghi, T., Grandi, A., Bilman, V., Melissano, G., Chiesa, R., and Bertoglio, L.
Subjects: Male, medicine.medical_specialty, Computed Tomography Angiography, medicine.medical_treatment, Vascular access, 030204 cardiovascular system & hematology, Prosthesis Design, Thoracoabdominal Aortic Aneurysms, Aortography, 03 medical and health sciences, Aortic aneurysm, 0302 clinical medicine, Aneurysm, medicine, Humans, Off the shelf, Branched design, Endovascular, Off-the-shelf, Pararenal, Thoracoabdominal, 030212 general & internal medicine, Single institution, Thoracoabdominal aneurysm, Aged, Retrospective Studies, business.industry, Endovascular Procedures, Stent, Prostheses and Implants, Middle Aged, medicine.disease, Surgery, Elective Surgical Procedures, cardiovascular system, Feasibility Studies, Female, Stents, Cardiology and Cardiovascular Medicine, business, Aortic Aneurysm, Abdominal, Follow-Up Studies
Abstract: Objective The objective of this study was to evaluate the proportion of pararenal aortic aneurysms and thoracoabdominal aortic aneurysms (TAAAs) that could theoretically be treated with the investigational GORE EXCLUDER Thoracoabdominal Branch Endoprosthesis (TAMBE; W. L. Gore & Associates, Flagstaff, Ariz) off-the-shelf multibranched endograft. Methods The preoperative computed tomography scans of patients with pararenal aortic aneurysms and TAAAs treated at a single institution between 2007 and 2017 were reviewed. This cohort included both open and endovascular repairs performed in either elective or urgent/emergent settings. These studies were included in a retrospective feasibility study to verify anatomic feasibility of the TAMBE graft (with four antegrade portals) employed within the manufacturer's investigational instructions for use during the U.S. pivotal trial. The patient cohort was divided into two groups: extended thoracoabdominal aneurysm (E-TAA)—extent I, II, and III TAAA; and limited pararenal and thoracoabdominal aneurysm (L-TAA)—pararenal aortic aneurysm and extent IV TAAA. The anatomic factors determining the overall theoretical feasibility were further divided into three groups: vascular access feasibility, aortic feasibility, and visceral vessel feasibility. Results Computed tomography scans of 227 patients with degenerative aneurysms were analyzed, 166 with E-TAA and 61 with L-TAA. In the L-TAA group, 49% of the cases could have been treated with the TAMBE endograft alone; access feasibility was 85%, aortic feasibility 74%, and visceral vessel feasibility 72%. In the E-TAA group, only 23% of the cases could have been treated with a TAMBE combined with a GORE CTAG proximal thoracic stent graft; access feasibility was 79%, aortic feasibility 48%, and visceral vessel feasibility 63%. The different feasibility rate was related to a difference in aortic feasibility between L-TAA and E-TAA (74% vs 48%; P = .0008) because of the lack of a dedicated tapered thoracic component. Conclusions The TAMBE multibranched endograft can theoretically be employed in half of an all-comers cohort of patients with degenerative L-TAA. Development of a dedicated tapered thoracic component is warranted to increase the feasibility for E-TAA, and comparative studies are required to investigate differences with other available off-the-shelf stent grafts.
Published: 2020

48. Carotid to subclavian bypass and Amplatzer vascular plug subclavian endovascular occlusion before thoracic open or endovascular repair

Author: Luca Bertoglio, Andrea Melloni, Tommaso Cambiaghi, Andrea Kahlberg, Roberto Chiesa, Simone Salvati, Germano Melissano, Alessandra Fittipaldi, Bertoglio, L., Salvati, S., Fittipaldi, A., Melloni, A., Kahlberg, A., Cambiaghi, T., Melissano, G., and Chiesa, R.
Subjects: Male, medicine.medical_specialty, Time Factors, Percutaneous, Subclavian artery, Databases, Factual, Elephant trunks, medicine.medical_treatment, Thoracic, Subclavian Artery, Aorta, Thoracic, 030204 cardiovascular system & hematology, Revascularization, Endovascular aneurysm repair, Blood Vessel Prosthesis Implantation, 03 medical and health sciences, Embolization, Postoperative Complications, 0302 clinical medicine, Aneurysm, Risk Factors, medicine.artery, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Radial artery, Vascular Patency, Aged, Retrospective Studies, business.industry, Endovascular Procedures, Middle Aged, medicine.disease, Embolization, Therapeutic, Surgery, Carotid Arteries, Treatment Outcome, Feasibility Studies, Female, Cardiology and Cardiovascular Medicine, business
Abstract: Objective The aim of this study was to evaluate the safety and effectiveness of endovascular occlusion of the prevertebral subclavian artery (SA) using an Amplatzer vascular plug after prophylactic revascularization with carotid-subclavian bypass (CSB) in the setting of endovascular thoracic stent grafting or open arch repair with frozen elephant trunk. Methods All patients who underwent SA plug embolization (SAPE) and CSB from September 2009 to December 2018 were enrolled in a registered study (SAPE study: clinicaltrials.gov NCT03620006 ). The primary end point was technical success, defined as complete occlusion of the origin of the SA, and how it was influenced by SA anatomy. The secondary end points were access vessel complications, cerebrovascular events, and CSB patency. Results The 101 SAPE procedures were performed using a type I (35 patients) or a type II (66 patients) Amplatzer vascular plug. A percutaneous ipsilateral upper extremity access was used in 66% of patients and a radial artery access was used in 50% of procedures. The 30-day primary technical success rate was 95% (five patients received an additional plug during the index); five type IC endoleaks were observed and successfully treated either with surgical ligation (in open arch repair procedures) or secondary embolization procedure (thoracic endovascular aneurysm repair group). Three access vessel complications (3%) were recorded with percutaneous brachial approach. At a median follow-up time of 11 months (range, 2-19 months), no new-onset type IC endoleak was observed, and the CSB patency rate was 97%. Conclusions SAPE after CSB is feasible and safe, and has low incidence of type IC endoleaks. Further device developments are needed to better adapt to the subclavian anatomy.
Published: 2020

49. Defining the Key Competencies in Radiation Protection for Endovascular Procedures

Author: Bart Doyen, Blandine Maurel, Jonathan Cole, Heidi Maertens, Tara Mastracci, Isabelle Van Herzeele, Bo Bech, Luca Bertoglio, Colin Bicknell, Marianne Brodmann, Tom Carrell, Tina Cohnert, Rick De Graaf, Jean Paul De Vries, Florian Dick, Fabrizio Fanelli, Roberto Ferraresi, Yann Gouëffic, Stéphan Haulon, Christos Karkos, Igor Končar, Mário Lachat, Johannes Lammer, Tim Lockie, Richard McWilliams, Germano Melissano, Stefan Müller-Hülsbeck, Christoph Nienaber, null O'Sullivan, Giuseppe Panuccio, Timothy Resch, Vincente Riambau, Robin Williams, Horst Sievert, Luc Stockx, Zoltán Szeberin, Joep Teijink, Paulo Gonçalves Dias, Josua Van Den Berg, Jan Van Der Heyden, Joost van Herwaarden, Frank Vermassen, Fabio Verzini, Anders Wanhainen, Doyen, Bart, Maurel, Blandine, Cole, Jonathan, Maertens, Heidi, Mastracci, Tara, Van Herzeele, Isabelle, Bech, Bo, Bertoglio, Luca, Bicknell, Colin, Brodmann, Marianne, Carrell, Tom, Cohnert, Tina, De Graaf, Rick, De Vries, Jean Paul, Dick, Florian, Fanelli, Fabrizio, Ferraresi, Roberto, Gouëffic, Yann, Haulon, Stéphan, Karkos, Christo, Končar, Igor, Lachat, Mário, Lammer, Johanne, Lockie, Tim, Mcwilliams, Richard, Melissano, Germano, Müller-Hülsbeck, Stefan, Nienaber, Christoph, O'Sullivan, Null, Panuccio, Giuseppe, Resch, Timothy, Riambau, Vincente, Williams, Robin, Sievert, Horst, Stockx, Luc, Szeberin, Zoltán, Teijink, Joep, Gonçalves Dias, Paulo, Van Den Berg, Josua, Van Der Heyden, Jan, van Herwaarden, Joost, Vermassen, Frank, Verzini, Fabio, Wanhainen, Anders, Obstetrics and gynaecology, Amsterdam Movement Sciences - Restoration and Development, Amsterdam Reproduction & Development (AR&D), RS: CAPHRI - R5 - Optimising Patient Care, and Epidemiologie
Subjects: Male, Delphi Technique, IMPACT, Delphi method, 030204 cardiovascular system & hematology, Electronic mail, 030218 nuclear medicine & medical imaging, Cardiologists, 0302 clinical medicine, Surveys and Questionnaires, Medicine, CRITERIA, Multispecialty, computer.programming_language, Delphi consensus, Education, Endovascular, Radiation protection, Surgery, Cardiology and Cardiovascular Medicine, Electronic Mail, Endovascular Procedures, INTERVENTIONAL RADIOLOGY, EDUCATION, Middle Aged, Female, Clinical Competence, Adult, Consensus, EUROPE, Attitude of Health Personnel, MEDLINE, SOCIETY, Likert scale, 03 medical and health sciences, JOINT GUIDELINE, Cronbach's alpha, Radiologists, Humans, KNOWLEDGE, EXPOSURE, Surgeons, Medical education, Delphi consensu, business.industry, X-Rays, FRAMEWORK, Key (cryptography), business, computer, Delphi
Abstract: Objectives: Radiation protection training courses currently focus on broad knowledge topics which may not always be relevant in daily practice. The goal of this study was to determine the key competencies in radiation protection that every endovascular team member should possess and apply routinely, through multispecialty clinical content expert consensus.Methods: Consensus was obtained through a two round modified Delphi methodology. The expert panel consisted of European vascular surgeons, interventional radiologists, and interventional cardiologists/angiologists experienced in endovascular procedures. An initial list of statements, covering knowledge skills, technical skills and attitudes was created, based on a literature search. Additional statements could be suggested by the experts in the first Delphi round. Each of the statements had to be rated on a 5-point Likert scale. A statement was considered to be a key competency when the internal consistency was greater than alpha = 0.80 and at least 80% of the experts agreed (rating 4/5) or strongly agreed (rating 5/5) with the statement. Questionnaires were emailed to panel members using the Surveymonkey service.Results: Forty-one of 65 (63.1%) invited experts agreed to participate in the study. The response rates were 36 out of 41 (87.8%): overall 38 out of 41(92.6%) in the first round and 36 out of 38 (94.7%) in the second round. The 71 primary statements were supplemented with nine items suggested by the panel. The results showed excellent consensus among responders (Cronbach's alpha = 0.937 first round; 0.958 s round). Experts achieved a consensus that 30 of 33 knowledge skills (90.9%), 23 of 27 technical skills (82.1%), and 15 of 20 attitudes (75.0%) should be considered as key competencies.Conclusions: A multispecialty European endovascular expert panel reached consensus about the key competencies in radiation protection. These results may serve to create practical and relevant radiation protection training courses in the future, enhancing radiation safety for both patients and the entire endovascular team. (C) 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
Published: 2018

50. Preliminary Results of Debranch-First Technique in Frozen Elephant Trunk Procedures

Author: Alessandro Verzini, Paola Redaelli, Alessandra Fittipaldi, Marta Bargagna, Tommaso Cambiaghi, Alessandro Castiglioni, Ilaria Giambuzzi, Ottavio Alfieri, Roberto Chiesa, Luca Bertoglio, Bertoglio, L., Fittipaldi, A., Giambuzzi, I., Redaelli, P., Verzini, A., Cambiaghi, T., Bargagna, M., Alfieri, O., Chiesa, R., and Castiglioni, A.
Subjects: Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, Elephant trunks, Ischemia, Aortic Diseases, 030204 cardiovascular system & hematology, Anastomosis, Prosthesis Design, law.invention, 03 medical and health sciences, Blood Vessel Prosthesis Implantation, 0302 clinical medicine, Blood vessel prosthesis, law, medicine, Cardiopulmonary bypass, Humans, Prospective Studies, Cerebral perfusion pressure, Prospective cohort study, Stroke, Aged, Retrospective Studies, business.industry, Middle Aged, medicine.disease, Surgery, Blood Vessel Prosthesis, Female, Treatment Outcome, Vascular Surgical Procedures, 030228 respiratory system, Cardiology and Cardiovascular Medicine, business
Abstract: Background To evaluate the outcomes of frozen elephant trunk (FET) procedures performed with a customized graft that allows debranch-first technique with continuous antegrade cerebral perfusion and early distal aortic and myocardial reperfusion. Methods Between 2016 and 2018 34 patients (30 men; median age, 59.7 years) were enrolled in an ambispective single-center study called FET Optimization (clinicaltrials.gov: NCT03600077). The patients underwent FET procedure using a novel modified E-Vita graft (JOTEC GmbH, Hechingen, Germany) plus graft with 2 dedicated reperfusion branches with debranch-first technique. Mortality and morbidity were primary endpoints. Secondary endpoints were overall duration of cardiopulmonary bypass, debranching, limb ischemia, cardiac ischemia, cerebral perfusion, and amount of aortic coverage. Results No deaths at 30 days were recorded, and the major adverse event (grade ≥ 2) rate was 33% (11 patients) including 1 (3%) nondisabling stroke and 1 (2.9%) permanent spinal cord ischemic event. Proximal FET collar anastomosis were in zone 0 (68%) or zone 1 (32%). Median cardiopulmonary bypass duration was 165 minutes (range, 144-185), distal aortic ischemic time 38 minutes (range, 32-45), and cardiac ischemic time 74 minutes (range, 62-94). The time of distal aortic ischemia was shorter in nonobese patients (27 vs 49 minutes, P = .043) and in zone 0 (23 cases) vs zone 1 (11 cases) anastomosis (34 vs 42 minutes, P = .043). Conclusions The FET procedure with debranch-first technique is safe and feasible and resulted in low mortality and morbidity rates. Further investigation is needed to compare it with standard techniques.
Published: 2019

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