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1. Sex Related Differences and Factors Associated With Peri-Procedural and One Year Mortality in Chronic Limb Threatening Ischaemia Patients

Author

Eugenio Martelli, Matilde Zamboni, Giovanni Sotgiu, Laura Saderi, Massimo Federici, Giuseppe Sangiorgi, Mariangela Valentina Puci, Allegra Rosa Martelli, Teresa Messina, Paolo Frigatti, Maria Pia Borrelli, Carlo Ruotolo, Ilaria Ficarelli, Paolo Rubino, Francesco Pezzo, Luciano Carbonari, Andrea Angelini, Edoardo Galeazzi, Luca Calia di Pinto, Franco Michelino Fiore, Armando Palmieri, Giorgio Ventoruzzo, Giulia Mazzitelli, Franco Ragni, Antonio Bozzani, Enzo Forliti, Claudio Castagno, Pietro Volpe, Mafalda Massaro, Diego Moniaci, Elisa Pagliasso, Tania Peretti, Mauro Ferrari, Nicola Troisi, Piero Modugno, Maurizio Maiorano, Umberto Marcello Bracale, Marco Panagrosso, Mario Monaco, Giovanni Giordano, Giuseppe Natalicchio, Antonella Biello, Giovanni Maria Celoria, Alessio Amico, Mauro Di Bartolo, Massimiliano Martelli, Roberta Munaò, Davide Razzano, Giovanni Colacchio, Francesco Bussetti, Gaetano Lanza, Antonio Cardini, Bartolomeo Di Benedetto, Mario De Laurentis, Maurizio Taurino, Pasqualino Sirignano, Pierluigi Cappiello, Andrea Esposito, Santi Trimarchi, Silvia Romagnoli, Andrea Padricelli, Giorgio Giudice, Adolfo Crinisio, Giovanni Di Nardo, Giuseppe Battaglia, Rosario Tringale, Salvatore De Vivo, Rita Compagna, Valerio Stefano Tolva, Ilenia D'Alessio, Ruggiero Curci, Simona Giovannetti, Giuseppe D'Arrigo, Giusi Basile, Dalmazio Frigerio, Gianfranco Veraldi, Luca Mezzetto, Arnaldo Ippoliti, Fabio Massimo Oddi, and Alberto Maria Settembrini

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701, Surgery, RD1-811
Published
2024
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2. Sex-Related Differences and Factors Associated with Peri-Procedural and 1 Year Mortality in Chronic Limb-Threatening Ischemia Patients from the CLIMATE Italian Registry

Author

Eugenio Martelli, Matilde Zamboni, Giovanni Sotgiu, Laura Saderi, Massimo Federici, Giuseppe M. Sangiorgi, Mariangela V. Puci, Allegra R. Martelli, Teresa Messina, Paolo Frigatti, Maria Pia Borrelli, Carlo Ruotolo, Ilaria Ficarelli, Paolo Rubino, Francesco Pezzo, Luciano Carbonari, Andrea Angelini, Edoardo Galeazzi, Luca Calia Di Pinto, Franco M. Fiore, Armando Palmieri, Giorgio Ventoruzzo, Giulia Mazzitelli, Franco Ragni, Antonio Bozzani, Enzo Forliti, Claudio Castagno, Pietro Volpe, Mafalda Massara, Diego Moniaci, Elisa Pagliasso, Tania Peretti, Mauro Ferrari, Nicola Troisi, Piero Modugno, Maurizio Maiorano, Umberto M. Bracale, Marco Panagrosso, Mario Monaco, Giovanni Giordano, Giuseppe Natalicchio, Antonella Biello, Giovanni M. Celoria, Alessio Amico, Mauro Di Bartolo, Massimiliano Martelli, Roberta Munaó, Davide Razzano, Giovanni Colacchio, Francesco Bussetti, Gaetano Lanza, Antonio Cardini, Bartolomeo Di Benedetto, Mario De Laurentis, Maurizio Taurino, Pasqualino Sirignano, Pierluigi Cappiello, Andrea Esposito, Santi Trimarchi, Silvia Romagnoli, Andrea Padricelli, Giorgio Giudice, Adolfo Crinisio, Giovanni Di Nardo, Giuseppe Battaglia, Rosario Tringale, Salvatore De Vivo, Rita Compagna, Valerio S. Tolva, Ilenia D’Alessio, Ruggiero Curci, Simona Giovannetti, Giuseppe D’Arrigo, Giusi Basile, Dalmazio Frigerio, Gian Franco Veraldi, Luca Mezzetto, Arnaldo Ippoliti, Fabio M. Oddi, and Alberto M. Settembrini

Subjects
chronic limb-threatening ischemia, outcome, sex, age, limb salvage, Medicine
Abstract

Background: Identifying sex-related differences/variables associated with 30 day/1 year mortality in patients with chronic limb-threatening ischemia (CLTI). Methods: Multicenter/retrospective/observational study. A database was sent to all the Italian vascular surgeries to collect all the patients operated on for CLTI in 2019. Acute lower-limb ischemia and neuropathic-diabetic foot are not included. Follow-up: One year. Data on demographics/comorbidities, treatments/outcomes, and 30 day/1 year mortality were investigated. Results: Information on 2399 cases (69.8% men) from 36/143 (25.2%) centers. Median (IQR) age: 73 (66–80) and 79 (71–85) years for men/women, respectively (p < 0.0001). Women were more likely to be over 75 (63.2% vs. 40.1%, p = 0.0001). More men smokers (73.7% vs. 42.2%, p < 0.0001), are on hemodialysis (10.1% vs. 6.7%, p = 0.006), affected by diabetes (61.9% vs. 52.8%, p < 0.0001), dyslipidemia (69.3% vs. 61.3%, p < 0.0001), hypertension (91.8% vs. 88.5%, p = 0.011), coronaropathy (43.9% vs. 29.4%, p < 0.0001), bronchopneumopathy (37.1% vs. 25.6%, p < 0.0001), underwent more open/hybrid surgeries (37.9% vs. 28.8%, p < 0.0001), and minor amputations (22% vs. 13.7%, p < 0.0001). More women underwent endovascular revascularizations (61.6% vs. 55.2%, p = 0.004), major amputations (9.6% vs. 6.9%, p = 0.024), and obtained limb-salvage if with limited gangrene (50.8% vs. 44.9%, p = 0.017). Age > 75 (HR = 3.63, p = 0.003) is associated with 30 day mortality. Age > 75 (HR = 2.14, p < 0.0001), nephropathy (HR = 1.54, p < 0.0001), coronaropathy (HR = 1.26, p = 0.036), and infection/necrosis of the foot (dry, HR = 1.42, p = 0.040; wet, HR = 2.04, p < 0.0001) are associated with 1 year mortality. No sex-linked difference in mortality statistics. Conclusion: Women exhibit fewer comorbidities but are struck by CLTI when over 75, a factor associated with short- and mid-term mortality, explaining why mortality does not statistically differ between the sexes.

Published
2023
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3. How the First Year of the COVID-19 Pandemic Impacted Patients’ Hospital Admission and Care in the Vascular Surgery Divisions of the Southern Regions of the Italian Peninsula

Author

Eugenio Martelli, Giovanni Sotgiu, Laura Saderi, Massimo Federici, Giuseppe Sangiorgi, Matilde Zamboni, Allegra R. Martelli, Giancarlo Accarino, Giuseppe Bianco, Francesco Bonanno, Umberto M. Bracale, Enrico Cappello, Giovanni Cioffi, Giovanni Colacchio, Adolfo Crinisio, Salvatore De Vivo, Carlo Patrizio Dionisi, Loris Flora, Giovanni Impedovo, Francesco Intrieri, Luca Iorio, Gabriele Maritati, Piero Modugno, Mario Monaco, Giuseppe Natalicchio, Vincenzo Palazzo, Fernando Petrosino, Francesco Pompeo, Raffaele Pulli, Davide Razzano, Maurizio R. Ruggieri, Carlo Ruotolo, Paolo Sangiuolo, Gennaro Vigliotti, Pietro Volpe, Antonella Biello, Pietro Boggia, Michelangelo Boschetti, Enrico M. Centritto, Flavia Condò, Lucia Cucciolillo, Amodio S. D’Amodio, Mario De Laurentis, Claudio Desantis, Daniela Di Lella, Giovanni Di Nardo, Angelo Disabato, Ilaria Ficarelli, Angelo Gasparre, Antonio N. Giordano, Alessandro Luongo, Mafalda Massara, Vincenzo Molinari, Andrea Padricelli, Marco Panagrosso, Anna Petrone, Serena Pisanello, Roberto Prunella, Michele Tedesco, and Alberto M. Settembrini

Subjects
COVID-19, carotid stenosis, abdominal aortic aneurysm, chronic limb-threatening ischemia, amputation, deep venous thrombosis, Medicine
Abstract

Background: To investigate the effects of the COVID-19 lockdowns on the vasculopathic population. Methods: The Divisions of Vascular Surgery of the southern Italian peninsula joined this multicenter retrospective study. Each received a 13-point questionnaire investigating the hospitalization rate of vascular patients in the first 11 months of the COVID-19 pandemic and in the preceding 11 months. Results: 27 out of 29 Centers were enrolled. April-December 2020 (7092 patients) vs. 2019 (9161 patients): post-EVAR surveillance, hospitalization for Rutherford category 3 peripheral arterial disease, and asymptomatic carotid stenosis revascularization significantly decreased (1484 (16.2%) vs. 1014 (14.3%), p = 0.0009; 1401 (15.29%) vs. 959 (13.52%), p = 0.0006; and 1558 (17.01%) vs. 934 (13.17%), p < 0.0001, respectively), while admissions for revascularization or major amputations for chronic limb-threatening ischemia and urgent revascularization for symptomatic carotid stenosis significantly increased (1204 (16.98%) vs. 1245 (13.59%), p < 0.0001; 355 (5.01%) vs. 358 (3.91%), p = 0.0007; and 153 (2.16%) vs. 140 (1.53%), p = 0.0009, respectively). Conclusions: The suspension of elective procedures during the COVID-19 pandemic caused a significant reduction in post-EVAR surveillance, and in the hospitalization of asymptomatic carotid stenosis revascularization and Rutherford 3 peripheral arterial disease. Consequentially, we observed a significant increase in admissions for urgent revascularization for symptomatic carotid stenosis, as well as for revascularization or major amputations for chronic limb-threatening ischemia.

Published
2022
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4. Sex-Related Differences and Factors Associated with Peri-Procedural and 1-year Mortality in Chronic Limb-Threatening Ischemia Patients from the CLIMATE Italian Registry

Author

Eugenio Martelli, Matilde Zamboni, Giovanni Sotgiu, Laura Saderi, Massimo Federici, Giuseppe Massimo Sangiorgi, Mariangela Valentina Puci, Allegra Rosa Martelli, Teresa Messina, Paolo Frigatti, Maria Pia Borrelli, Carlo Ruotolo, Ilaria Ficarelli, Paolo Rubino, Francesco Pezzo, Luciano Carbonari, Andrea Angelini, Edoardo Galeazzi, Luca Calia Di Pinto, Franco Michelino Fiore, Armado Palmieri, Giorgio Ventoruzzo, Giulia Mazzitelli, Franco Ragni, Antonio Bozzani, Enzo Forliti, Claudio Castagno, Pietro Volpe, Mafalda Massara, Diego Moniaci, Elisa Pagliasso, Tania Peretti, Mauro Ferrari, Nicola Troisi, Pietro Modugno, Maurizio Maiorano, Umberto Marcello Bracale, Marco Panagrosso, Mario Monaco, Giovanni Giordano, Giuseppe Natalicchio, Antonella Biello, Giovanni Maria Celoria, Alessio Amico, Mauro Di Bartolo, Massimiliano Martelli, Roberta Munaó, Davide Razzano, Giovanni Colacchio, Francesco Bussetti, Gaetano Lanza, Antonio Cardini, Bartolomeo Di Benedetto, Mario De Laurentis, Maurizio Taurino, Pasqualino Sirignano, Pierluigi Cappiello, Andrea Esposito, Santi Trimarchi, Silvia Romagnoli, Andrea Padricelli, Giorgio Giudice, Adolfo Crinisio, Giovanni Di Nardo, Giuseppe Battaglia, Rosario Tringale, Salvatore De Vivo, Rita Compagna, Valerio Stefano Tolva, Ilenia D'Alessio, Ruggiero Curci, Simona Giovannetti, Giuseppe D'Arrigo, Giusi Basile, Dalmazio Frigerio, Gian Franco Veraldi, Luca Mezzetto, Arnaldo Ippoliti, Fabio Massimo Oddi, and Alberto Maria Settembrini

Subjects
general_medical_research
Abstract

Background: Identifying sex-related differences/variables associated with 30-day/1-year mortality in patients with chronic limb-threatening ischemia (CLTI). Methods: Multicenter/retrospective/observational study. Database sent to all-the-Italian vascular surgeries to collect all-the¬-patients operated for CLTI in 2019. Acute lower-limb ischemia and neuropathic-diabetic foot not included. Follow-up: 1-year. Data on demographics/comorbidities, treatments/outcome, and 30-day/1-year mortality investigated. Results: Information on 2399 cases (69.8% men) from 36/143 (25.2%) centers. Median (IQR) age: 73 (66-80) and 79 (71-85) yrs for men/women, respectively (p75 (HR3.63, p=.003) associated with 30-day mortality. Age >75 (HR2.14, p

Published
2022

5. How the First Year of the COVID-19 Pandemic Impacted Patients’ Care in the Vascular Surgery Divisions of the Southern Regions of the Italian Peninsula

Author

Eugenio Martelli, Giovanni Sotgiu, Laura Saderi, Massimo Federici, Giuseppe Sangiorgi, Matilde Zamboni, Allegra Rosa Martelli, Giancarlo Accarino, Giuseppe Bianco, Francesco Bonanno, Umberto Marcello Bracale, Enrico Cappello, Giovanni Cioffi, Giovanni Colacchio, Adolfo Crinisio, Salvatore De Vivo, Carlo Patrizio Dionisi, Loris Flora, Giovanni Impedovo, Francesco Intrieri, Luca Iorio, Gabriele Maritati, Piero Modugno, Mario Monaco, Giuseppe Natalicchio, Vincenzo Palazzo, Fernando Petrosino, Francesco Pompeo, Raffaele Pulli, Davide Razzano, Maurizio Ruggero Ruggieri, Carlo Ruotolo, Paolo Sangiuolo, Gennaro Vigliotti, Pietro Volpe, Antonella Biello, Pietro Boggia, Michelangelo Boschetti, Enrico Maria Centritto, Flavia Condò, Lucia Cucciolillo, Amodio Salvatore D'Amodio, Mario De Laurentis, Claudio Desantis, Daniela Di Lella, Giovanni Di Nardo, Angelo Disabato, Ilaria Ficarelli, Angelo Gasparre, Antonio Nicola Giordano, Alessandro Luongo, Mafalda Massara, Vincenzo Molinari, Andrea Padricelli, Marco Panagrosso, Anna Petrone, Serena Pisanello, Roberto Prunella, Michele Tedesco, and Alberto Maria Settembrini

Subjects
medicine_pharmacology_other
Abstract

Background: To investigate the effects of the COVID-19 lockdowns on the vasculopathic population. Methods: The Divisions of Vascular Surgery of the southern Italian peninsula joined this multicenter retrospective study conducted through cross-sectional survey. Each received a 13-point questionnaire, investigating the hospitalization rate of vascular patients in the first 11 months of the COVID-19 pandemic and in the preceding 11 months. Results: 27 out of 29 Centers were enrolled. April-December 2020 (7092 patients) vs 2019 (9161 patients): post-EVAR surveillance, treatment for Rutherford category 3 peripheral arterial disease, and asymptomatic carotid stenosis revascularization significantly decreased [1484 (16.2%) vs 1014 (14.3%), p=0.0009; 1401 (15.29%) vs 959 (13.52%), p=0.0006; and 1558 (17.01%) vs 934 (13.17%), p

Published
2022

6. The Endovascular Management of an Iatrogenic Superior Gluteal Artery Rupture Following Bone Marrow Biopsy

Author

Doriana Ferrara, Donatella Narese, Luca del Guercio, Andrea Padricelli, Umberto Bracale, Flavia Spalla, Claudia De Gregorio, DE GREGORIO, Claudia, Spalla, Flavia, Padricelli, Andrea, Narese, Donatella, Bracale, Umberto, Ferrara, Doriana, DEL GUERCIO, Luca, and Bracale, UMBERTO MARCELLO

Subjects
endovascular treatment, Adult, medicine.medical_specialty, Aortic Rupture, Biopsy, Iatrogenic Disease, Case Report, Hemorrhage, iatrogenic complication, 030204 cardiovascular system & hematology, Iliac crest, Iliac Artery, 03 medical and health sciences, 0302 clinical medicine, Bone Marrow, Superior gluteal artery, medicine.artery, Internal Medicine, medicine, Humans, Aorta, Abdominal, Retroperitoneal Space, Endovascular treatment, Coil embolization, medicine.diagnostic_test, business.industry, Endovascular Procedures, General Medicine, Embolization, Therapeutic, Extravasation, Surgery, medicine.anatomical_structure, bone marrow biopsy, Treatment Outcome, Hemorrhagic complication, superior gluteal artery, Female, Radiology, Bone marrow, business, 030215 immunology
Abstract

We herein report an uncommon case of a life-threatening retroperitoneal hematoma after a bone marrow biopsy. Two hours after iliac crest bone harvesting, the patient experienced syncope and severe hypotension. Urgent contrast-enhanced computed tomography demonstrated extravasation from the superior gluteal artery. Transcatheter coil embolization was performed successfully, without complications. Life-threatening complications caused by retroperitoneal bleeding after bone marrow biopsy are very rare. There are few reports on the use of endovascular treatment in the management of life-threatening hemorrhagic complications after bone marrow biopsy.

Published
2017

7. Severe Mesenteric Ischemia in a Pregnant Woman with Antiphospholipid Syndrome

Author

Giuseppe Servillo, Carlo Ruotolo, Flavia Spalla, Umberto Bracale, Anna Maria Giribono, Luca del Guercio, Andrea Padricelli, Doriana Ferrara, Padricelli, Andrea, Giribono, ANNA MARIA, Ferrara, Doriana, Spalla, Flavia, Bracale, Umberto, DEL GUERCIO, Luca, Servillo, Giuseppe, Ruotolo, Carlo, and Bracale, UMBERTO MARCELLO

Subjects
Adult, medicine.medical_specialty, Computed Tomography Angiography, Deep vein, medicine.medical_treatment, Pregnancy Complications, Cardiovascular, 030204 cardiovascular system & hematology, Revascularization, Severity of Illness Index, Inferior mesenteric artery, 03 medical and health sciences, 0302 clinical medicine, Mesenteric Artery, Superior, Pregnancy, Antiphospholipid syndrome, medicine.artery, Mesenteric Vascular Occlusion, medicine, Humans, Saphenous Vein, Splanchnic Circulation, Superior mesenteric artery, Vein, 030203 arthritis & rheumatology, business.industry, Angiography, Digital Subtraction, Anticoagulants, Thrombosis, General Medicine, Antiphospholipid Syndrome, medicine.disease, Surgery, Treatment Outcome, medicine.anatomical_structure, Mesenteric ischemia, Mesenteric Ischemia, Female, Vascular Grafting, business, Cardiology and Cardiovascular Medicine
Abstract

The antiphospholipid syndrome (APS), either primary or secondary form, is considered an autoimmune disease with the presence of at least 1 clinical and 1 laboratory abnormalities as defined by the Sydney criteria. Clinical criteria include vascular thrombosis of venous, artery, small vessel in any organ, and recurrent pregnancy pathologies. Mesenteric ischemia is a rare and threatening manifestation of APS. We herein report a case of a 34-year-old pregnant woman referred to our Emergency Room with thoracic and abdominal acute pain. Her past medical history was remarkable for positivity to antiphospholipid antibodies, deep vein thrombosis of the right lower limb, chronic occlusion of celiac trunk, and superior mesenteric artery and recurrent abortions. Imaging revealed acute occlusion of inferior mesenteric artery (IMA). Both a surgical and endovascular thrombectomy were ineffective to obtain durable IMA patency and so the patient underwent antegrade aorta-inferior mesenteric bypass with saphenous vein and resection of an ischemic ileal loop. The medical treatment at discharge was lifelong oral anticoagulant associated with double antiplatelet therapy. To the best of our knowledge, this is the first case reporting a young pregnant woman with APS and mesenteric ischemia submitted to several attempts of revascularization. Aggressive oral anticoagulant and antiplatelet long-term therapy is advised. Moreover, we recommend strict follow-up in those patients in order to early diagnose thrombotic recurrence.

Published
2017

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