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1. Passive temporary arterial shunt for visceral and distal aortic perfusion during complex aortic surgery

Author

Antonio Luparelli, MD, Marta Minucci, MD, Federica Donato, MD, Giovanni Tinelli, MD, PhD, Tommaso Donati, MD, and Yamume Tshomba, MD

Subjects
Aortic aneurysm, Perfusion, Organ protection, Aortic operation, Off pump, TAAA surgical repair, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

On-pump techniques are the methods of choice for organ protection and heart support during thoracoabdominal aortic aneurysm surgical repair. We present a case of a patient with a symptomatic saccular aneurysm of the visceral segment of a severe atheromatous aorta requiring a surgical type IV aortic repair during which we adopted a temporary passive arterial shunt from the left axillary artery to ensure visceral and distal aortic perfusion. The old-fashioned technique of passive shunting to ensure visceral and distal aortic perfusion seems to offer an appealing alternative to on-pump techniques in selected patients.

Published
2024
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2. Physician-modified endograft for symptomatic zone 2 penetrating ulcer of the aortic arch without bridging stenting of the left subclavian artery for vertebral preservation

Author

Pierfrancesco Antonio Annuvolo, MD, Ottavia Borghese, MD, Tommaso Donati, MD, Giovanni Tinelli, MD, and Yamume Tshomba, MD

Subjects
Endovascular repair, Homemade endograft, Physician-modified stent graft, Fenestration, Surgeon-modified stent graft, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

We report the case of a 65-year-old male patient who was deemed unfit for open surgery and underwent zone 0 endovascular repair with a physician-modified fenestrated endograft for a symptomatic penetrating ulcer. A thoracic stent graft was modified creating a large fenestration for the innominate artery and the left common carotid artery, and a second small fenestration for the left subclavian artery and the left vertebral artery, which had a common origin. No bridging stent was used for the left subclavian artery to avoid coverage of the left vertebral artery. The postoperative course was uneventful, and no leaks nor other complications were detected on postoperative computed tomography angiography. Although long-term durability needs to be better assessed, our experience suggests that physician-modified fenestrated endografts are a feasible option for the emergent treatment of aortic arch lesions in unfit patients and provide satisfactory results in the short term.

Published
2024
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3. Outcomes Following Vascular and Endovascular Procedures Performed During the First COVID-19 Pandemic Wave

Author

Panagiota Birmpili, Ruth A. Benson, Brenig Gwilym, Sandip Nandhra, Nina Al-Saadi, Graeme K. Ambler, Robert Blair, David Bosanquet, Nikesh Dattani, Louise Hitchman, Katherine Hurndall, Matthew Machin, Sarah Onida, Athanasios Saratzis, Joseph Shalhoub, Lauren Shelmerdine, Aminder A. Singh, Lauren, Shelmerdine, Aminder Anthony Singh, David C. Bosanquet, Rachael O. Forsythe, George Dovell, Ryan Preece, Chris Imray, Sonia Kandola, Adam Johnson, Andrew Choong, Jun Jie Ng, Sarah Aitken, Jana-Lee Moss, Efthymios Beropoulis, Konstantinos Stavroulakis, Fabrico Santiago, Amr Abdelhaliem, Aseel Abuduruk, Thomas M. Aherne, Hazem Ahmed, Sarah J. Aitken, Tasleem Akhtar, Bekir B. Akkaya, Julien Al Shakarchi, Abdeljawad J. Algasi, Musaad AlHamzah, Ahmed A. Alhumiad, Bernard Allard, Meshal Almeshal, Faris Alomran, Reem N. AlRakaf, Mohamed Altabal, Nishath Altaf, Abdulmajeed H. Altoijry, Talal Altuwaijri, Nasser Alwehaibi, Sara J. Anderson Baker, Domenico Angiletta, Afroditi Antoniou, George A. Antoniou, Libnah L. Areias, James Ashcroft, Noel Atkinson, Doaa Attia, Lukas Attwell, Mohammed A. Azab, Omar Aziz, Ahmed Y. Azzam, Christos Bakoyiannis, Hashem Barakat, Khalid Bashar, Ruth Battersby, K.S. Benaragama, Ahmed T.S. BenGhatnsh, Nikolaos Bessias, Resya Bhakthavalsalan, Shagran Binkhamis, Roshan Bootun, Emily Boyle, Ion Buga, Martin Catterson, Jennifer L. Chambers, Karishma Chandarana, Alexandros Charalabopoulos, Gabriella Charlton, Stephen W.K. Cheng, Natasha Chinai, Asad J. Choudhry, Annie Clothier, Tina U. Cohnert, Chloe Coleman, Michael Costanza, Patrick A. Coughlin, James Coulston, James Cragg, Katy Darvall, Emma M. Davies, Huw Davies, Claire Dawkins, Joseph A. Dawson, Anastasia Dean, Bedanta S. Dhal, Andrew Duncan, Mark Edwards, Bridget Egan, Mehdi El Amrani, Ahmed Elhadi, Muhammed Elhadi, Mohamed S. Eljareh, Ramy Elkady, Mohamed Elkawafi, Fatimah S. Elkhafeefi, Maysoon Elkwahad, Ibrahim A. Ellojli, Kareem ElSanhoury, Hazem Elsantawy, Khaled Elsayed, Raed M. Ennab, Owain Fisher, Robert Fitridge, Ronald L.G. Flumignan, Amy L. Fowler, Richard F. Galloway, John Gan, Andrew Garnham, Sotirios Georgopoulos, Tamer M.H. Ghatwary Tantawy, Ravi R. Goel, Mingzheng A. Goh, Tabitha Grainger, Nalaka Gunawansa, Eric Hammond, Joseph Hanna, Simon C. Hardy, Thomas J. Hardy, Gareth J. Harrison, Ahmed Hassanin, Andrew T. Hattam, Martin Hein, Hytham K.S. Hmaid, Kay Hon, Kaisor Iqbal, Hakkı Z. Iscan, Arda Isik, Doireann P. Joyce, Maciej Juszczak, Kiriaki Kakavia, Stavros Kakkos, Christos D. Karkos, Emmanuel Katsogridakis, Rana Khalil, Andrew I. Khallaf, Aazeb Khan, Manar Khashram, Samantha Khoo, Joseph Kilby, Beatrice Kuang, Ioanna Kyrou, Pierfrancesco Lapolla, Kai W. Leong, Eunice Lim, Ju-wei N. Liu, Dafydd Locker, Xun Luo, Oliver T.A. Lyons, Ragai R. Makar, Dimitris Maras, Emmeline A. Martin, Hayrettin L. Mavioglu, Dennis Mazingi, James McCaslin, David N. McClure, Kevin McKevitt, Lewis Meecham, Shreya Mehta, Fabrizio Minelli, Andrea Mingoli, Afroditi M. Mitka, Farag S. Mohamed, Hayley M. Moore, Rachael L. Morley, Konstantinos G. Moulakakis, Eustratia Mpaili, Ahmed Msherghi, Kamel Muhammad, Juanita Muller, Korana Musicki, Luis C.U. Nakano, Craig Nesbitt, Jonathan Nicholls, Andrew Nickinson, Thamer Nouh, Jose M.S. Nunag, Isaac K. Nyamekye, Michael J. Papanikolas, Theofanis T. Papas, Konstantinos O. Papazoglou, Sharath Paravastu, Noala Parr, Ketino Pasenidou, Fernando Picazo Pineda, Franklin Pond, Matthew A. Popplewell, Katarzyna Powezka, Daniela Prce, Sivaram Premnath, Raffaele Pulli, Hussein M.M. Rabee, Habibur P. Rahman, Nandhini Ravintharan, Andrés Reyes Valdivia, Toby Richards, Konstantinos Roditis, Alexander E.S. Rolls, Iain N. Roy, Hani Saeed, Prakash Saha, Alberto Saltiel, Paolo Sapienza, Emma Scott, Christopher N. Selvaraj, Atif Sharif, Simona Sica, Justinas Silickas, Gurkirat Singh, Ashwin Sivaharan, Yogeesan Sivakumaran, Pranav Somaiya, Gerry Stansby, Bethany M. Stavert, Abhilash Sudarsanam, Elizabeth Suthers, Helen Suttenwood, Ahmed Taha, Mohamed A.H. Taha, Siu C. Tam, Alethea M. Tang, Robert Tang, Dana Taran, Lawrence Tarusan, Myat S. Thet, Jacqueline Thomas, Sean Tierney, Konstantinos Tigkiropoulos, Giovanni Tinelli, Mahmoud M.H. Tolba, Hannah C. Travers, Ioannis Tsagkos, Yamume Tshomba, Paraskevi Tsiantoula, Christopher P. Twine, Berkay Ulker, Serap Ulusoy, Ertekin U. Unal, Vincent C. Varley, Thodur M. Vasudevan, Uyen G. Vo, Timothy Wagner, Stewart R. Walsh, Judy Wang, Jackie Wong, Sarah A. Warren, Chun L.P. Yih, Sergio Zacà, Adeel S. Zafar, Shady Zaki, and Ewa M. Zywicka

Subjects
Vascular surgery, COVID-19, Coronavirus, Mortality, Diseases of the circulatory (Cardiovascular) system, RC666-701, Surgery, RD1-811
Abstract

Objective: The first COVID-19 pandemic wave was a period of reduced surgical activity and redistribution of resources to only those with late stage or critical presentations. This Vascular and Endovascular Research Network COVID-19 Vascular Service (COVER) study aimed to describe the six-month outcomes of patients who underwent open surgery and or endovascular interventions for major vascular conditions during this period. Methods: In this international, multicentre, prospective, observational study, centres recruited consecutive patients undergoing vascular procedures over a 12-week period. The study opened in March 2020 and closed to recruitment in August 2020. Patient demographics, procedure details, and post-operative outcomes were collected on a secure online database. The reported outcomes at 30 days and six months were post-operative complications, re-interventions, and all cause in-hospital mortality rate. Multivariable logistic regression was used to assess factors associated with six-month mortality rate. Results: Data were collected on 3 150 vascular procedures, including 1 380 lower limb revascularisations, 609 amputations, 403 aortic, 289 carotid, and 469 other vascular interventions. The median age was 68 years (interquartile range 59, 76), 73.5% were men, and 1.7% had confirmed COVID-19 disease. The cumulative all cause in-hospital, 30-day, and six-month mortality rates were 9.1%, 10.4%, and 12.8%, respectively. The six-month mortality rate was 32.1% (95% CI 24.2–40.8%) in patients with confirmed COVID-19 compared with 12.0% (95% CI 10.8–13.2%) in those without. After adjustment, confirmed COVID-19 was associated with a three times higher odds of six-month death (adjusted OR 3.25, 95% CI 2.18–4.83). Increasing ASA grade (3–5 vs. 1–2), frailty scores 4–9, diabetes mellitus, and urgent and or immediate procedures were also independently associated with increased odds of death by six months, while statin use had a protective effect. Conclusion: During the first wave of the pandemic, the six-month mortality rate after vascular and endovascular procedures was higher compared with historic pre-pandemic studies and associated with COVID-19 disease.

Published
2024
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4. Extensive congenital asymptomatic renal arteriovenous malformation

Author

Simona Sica, Francesca De Nigris, Fabrizio Minelli, Alessandro Cina, Giovanni Tinelli, and Yamume Tshomba

Subjects
AV malformations., Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Renal arteriovenous malformations (AVM) are abnormal communications between the intrarenal arterial and venous systems. These lesions may present with a wide range of signs and symptoms, including hypertension and hematuria. We report a case of a 71-year-old woman with incidentally diagnosis of asymptomatic right renal AVM.

Published
2023
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5. Intraoperative immunomodulation during left heart bypass in open thoracoabdominal aortic aneurysm repair

Author

Federico Pascucci, MD, Tommaso Donati, MD, Giovanni Tinelli, MD, PhD, Gabriella Arlotta, MD, Antonio Luparelli, MD, and Yamume Tshomba, MD

Subjects
CytoSorb, Left heart bypass, Thoracoabdominal aortic aneurysm, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Despite the technical innovations introduced in the previous decades, open thoracoabdominal aortic aneurysm repair still represents an enormous challenge for patients and surgeons. Logically, the systemic inflammatory response resulting from these massive operations appears considerable; however, the response has never been thoroughly investigated. In addition, intraoperative adjuncts to modulate the postoperative activation of the immune system have not yet been introduced into clinical practice. We report a case of intraoperative hemadsorption during open repair of a thoracoabdominal aortic aneurysm through the introduction of a CytoSorb device (CytoSorbents Corp) in the left heart bypass circuit. The technique appeared feasible and safe and probably contributed to the good clinical outcomes.

Published
2023
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6. Development of Disposables and Accessories for ROSES and Their In Vitro Experimentation

Author

Guido Danieli, Pasquale F. Greco, Gabriele Larocca, Salvatore De Rosa, Ciro Indolfi, Alberto Polimeni, Massimo Massetti, Giovanni Tinelli, Yamume Tshomba, and Luigi Venturini

Subjects
least invasive surgery, endovascular surgery, PTC (Percutaneous Trans Catheter) angioplasty, aneurysms repair, transcatheter aortic valve implant, Engineering (General). Civil engineering (General), TA1-2040
Abstract

This paper describes the development of the disposables and accessories for ROSES (Robotic System for Endovascular Surgery). Initially developed exclusively for transcatheter percutaneous coronary angioplasty, it was later modified, initially leaving the components for angioplasty substantially unchanged to extend its use to endovascular transcatheter surgery. These disposables are used to translate gear rotations into catheter or guide wire advancement or retraction and rotation of their body through friction wheels. The use of a new cart was necessary for endovascular surgery, to which a system to measure forces opposed by the patient’s body to catheter advancement was added. Moreover, since some endovascular catheters present with large diameters, minor mechanical modifications were also performed on the robot actuator (RA), previously defined as a slave, in order to allow large catheters to be pushed, such as those needed for the repair of some big aneurysms or for TAVI. However, in doing this, the possibility of separating the disposables into two components, upper and lower, was found, which allows the extraction of the disposable without having to remove the catheter or guide wire already positioned. Finally, the disposables, whose development is illustrated here, were subjected to various versions and tests and the results are reported.

Published
2022
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7. In situ reconstruction of distal renal artery aneurysm with renal perfusion: A case series

Author

Francesca Montanari, Giovanni Tinelli, Jacopo Romagnoli, Federica Donato, Fabrizio Minelli, Tommaso Donati, and Yamume Tshomba

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701, Surgery, RD1-811
Abstract

The treatment of renal artery aneurysms located from the mid to distal portion of the vessel is challenging. The complexity is related to the frequent involvement of side branches and to the risk of postoperative renal impairment. We report five cases of multidisciplinary treatment of distal renal artery aneurysms, adopting in situ reconstruction technique and renal perfusion with Custodiol solution, with satisfactory early and mid-term outcomes.

Published
2023
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8. Through-and-through femorofemoral wire retrograde technique for the E-nside precannulated inner branch thoracoabdominal stent graft

Author

Giovanni Tinelli, MD, PhD, Fabrizio Minelli, MD, Federica Donato, MD, Simona Sica, MD, Francesca De Nigris, MD, and Yamume Tshomba, MD

Subjects
E-nside, Multibranched stent graft, Personalized medicine, Target vessel, Through-and-through technique, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

The E-nside multibranched stent graft (Jotec GmbH, Hechingen, Germany) is the first and only off-the-shelf thoracoabdominal prosthesis with precannulated inner branches. Usually, after the device deployment, target vessel stenting will be facilitated by antegrade inner branch cannulation to retrieve the precannulated guide. In the literature, the use of antegrade access has been associated with the potential risk of cerebral and systemic embolization. Therefore, other retrograde techniques have been described. We have reported a new retrograde approach using a precannulated through-and-through femorofemoral wire technique for target vessel catheterization.

Published
2022
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9. Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study

Author

Ruth A. Benson, Maria Antonella Ruffino, Sharon Chan, Patrick Coughlin, Ayoola Awopetu, Philip Stather, Tristan Lane, Dimitrios Theodosiou, Mohamed Abozeid Ahmed, Thodur Vasudevan, Mohammed Ibrahim, Faraj Al Maadany, Mohamed Eljareh, Fatimah Saad Alkhafeefi, Raphael Coscas, Ertekin Utku Ünal, Raffaele Pulli, Sergio Zacà, Domenico Angiletta, Thomas Kotsis, Magdy Moawad, Matteo Tozzi, Nikolaos Patelis, Andreas M. Lazaris, Jason Chuen, Alexander Croo, Elpiniki Tsolaki, Gladiol Zenunaj, Dhafer Kamal, Mahmoud MH. Tolba, Martin Maresch, Vipul Khetarpaul, Joseph Mills, Gaurav Gangwani, Mohamed Elahwal, Rana Khalil, Mohammed A. Azab, Anver Mahomed, Richard Whiston, Ummul Contractor, Davide Esposito, Carlo Pratesi, Elena Giacomelli, Martín Veras Troncoso, Stephane Elkouri, Flavia Gentile Johansson, Ilias Dodos, Marie Benezit, José Vidoedo, João Rocha-Neves, António Henrique Pereira-Neves, Marina Felicidade Dias-Neto, Ana Filipa Campos Jácome, Luis Loureiro, Ivone Silva, Rodrigo Garza-Herrera, Victor Canata, Charlotte Bezard, Kathryn Bowser, Jorge Felipe Tobar, Carlos Gomez Vera, Carolina Salinas Parra, Eugenia Lopez, Yvis Gadelha Serra, Juan Varela, Vanessa Rubio, Gerardo Victoria, Adam Johnson, Leigh Ann O’Banion, Ragai Makar, Tamer Ghatwary Tantawy, Martin Storck, Vincent Jongkind, Orwa falah, Olivia McBride, Arda Isik, Athanasios Papaioannou, Paulo Eduardo Ocke Reis, Umberto Marcello Bracale, Ellie Atkins, Giovanni Tinelli, Emma Scott, Lucy Wales, Ashwin Sivaharan, Georgia Priona, Craig Nesbitt, Tabitha Grainger, Lauren Shelmerdine, Patrick Chong, Adnan Bajwa, Luke Arwynck, Nancy Hadjievangelou, Ahmed Elbasty, Oscar Rubio, Michael Ricardo, Jorge H. Ulloa, Marcos Tarazona, Manuel Pabon, Georgios Pitoulias, Kevin Corless, Orestis Ioannidis, Oliver Friedrich, Isabelle Van Herzeele, Badri Vijaynagar, Tina Cohnert, Rachel Bell, Hayley Moore, Prakash Saha, Edward Gifford, Matti Laine, Adel Barkat, Christos Karkos, Lenny Suryani Binti Safri, Gabriel Buitron, Javier Del Castillo, Paul Carrera, Nilson Salinas, Rodrigo Bruno Biagioni, Sergio Benites, César Andrés Mafla, Putera Mas Pian, Pereira Albino, Ernesto Serrano, Andres Marin, Marco González, Marsha Foreroga, Alejandro Russo, Andrés Reyes, Daniel Guglielmone, Lorena Grillo, Ronald Flumignan, Francisco Gomez Palones, Pierre Galvagni Silveira, Rosnelifaizur Bin Ramely, Sara Edeiken, Ian Chetter, Lucy Green, Abhilash Sudarsanam, Oliver Lyons, Gary Lemmon, Richard Neville, Mariano Castelli, Carlos A. Hinojosa, Rubén Rodríguez Carvajal, Aksim Rivera, Peng Wong, Laura Drudi, Jeremy Perkins, Kishore Sieunarine, Doaa Attia, Mahmoud Atef, Lostoridis Eftychios, Fred Weaver, Leong Chuo Ren, Mohannad Alomari, Reda Jamjoom, Qusai Aljarrah, Ayman Abbas, Faris Alomran, Ambrish Kumar, Abdulmajeed Altoijri, Kareem T. ElSanhoury, Ahmed Alhumaid, Tamer Fekry, Raghuram Sekhar, Panagiotis Theodoridis, Theodoridis Panagiotis, Konstantinos Roditis, Paraskevi Tsiantoula, Afroditi Antoniou, Raphael Soler, Natasha Hasemaki, Efstratia Baili, Eustratia Mpaili, Bella Huasen, Tom Wallace, Andrew Duncan, Matthew Metcalfe, Kristyn Mannoia, Carlos F. Bechara, Nikolaos Tsilimparis, Nathan Aranson, David Riding, Mariano Palena, Ciarán McDonnell, Nicolas J. Mouawad, Shonda Banegas, Peter Rossi, Taohid Oshodi, Rodney Diaz, Rana Afifi, Shiva Dindyal, Ankur Thapar, Ali Kordzadeh, Gonzalo Pullas, Stephanie Lin, Chris Davies, Katy Darvall, Akio Kodama, Thushan Gooneratne, Nalaka Gunawansa, Alberto Munoz, Ng Jun Jie, Nicholas Bradley, Wissam Al-Jundi, Felicity Meyer, Cheong Lee, Martin Malina, Sophie Renton, Dennis Lui, Andrew Batchelder, Grzegorz Oszkinis, Antonio Freyrie, Jacopo Giordano, Nikolaos Saratzis, Konstantinos Tigkiropoulos, Stavridis Kyriakos, Guriy Popov, Muhammad Usman Cheema, Pierfrancesco Lapolla, Yih Chun Ling Patricia, Raed Ennab, Brant W. Ullery, Ketino Pasenidou, Jacky Tam, Gabriel Sidel, Vivek Vardhan Jayaprakash, Lisa Bennett, Simon Hardy, Emma Davies, Sara Baker, Lasantha Wijesinghe, Adam Tam, Ken McCune, Manik Chana, Chris Lowe, Aaron Goh, Katarzyna Powezka, Ioanna Kyrou, Nishath Altaf, Denis Harkin, Hannah Travers, James Cragg, Atif sharif, Tasleem Akhtar, José Antonio Chávez, Claudia Ordonez, Martin Mazzurco, Edward Choke, Imran Asghar, Virginia Summerour, Paul Dunlop, Rachel Morley, Thomas Hardy, Paul Bevis, Robert Cuff, Konstantinos Stavroulakis, Efthymios Beropoulis, Angeliki Argyriou, Ian Loftus, Bilal Azhar, Sharvil Sheth, Marco Virgilio Usai, Asad Choudhry, Kira Nicole, Emily Boyle, Doireann Joyce, Mohammed Hassan Abdelaty Hassan, Alberto Saltiel, Gert Frahm-Jensen, George Antoniou, Muhammed Elhadi, Ali Kimyaghalam, Rafael Malgor, Leigh Ann O'Banion, Diego Telve, Andrej Isaak, Jürg Schmidli, Kevin McKevitt, Tam Siddiqui, Giuseppe Asciutto, Nikolaos Floros, George Papadopoulos, Alexandros Kafetzakis, Stylianos G. Koutsias, Petroula Nana, Athanasios Giannoukas, Stavros Kakkos, Konstantinos G. Moulakakis, Natasha Shafique, Arkadiusz Jawien, Matthew Popplewell, Chris Imray, Kumar Abayasekara, Timothy Rowlands, Ganesh Kuhan, Sriram Rajagopalan, Anthony Jaipersad, Uzma Sadia, Isaac Kobe, Devender Mittapalli, Ibrahim Enemosah, Christian-Alexander Behrendt, Adam Beck, Muayyad Almudhafer, Stefano Ancetti, Donald Jacobs, Priya Jayakumar, Fatemeh Malekpour, Sherene Shalhub, Boboyor Keldiyorov, Meryl Simon, Manar Khashram, Nicole Rich, Amanda Shepherd, Lewis Meecham, and Daniel Doherty

Subjects
AAA, COVID-19, PAD, Survey, Vascular surgery, Diseases of the circulatory (Cardiovascular) system, RC666-701, Surgery, RD1-811
Abstract

Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March – May 2020, “period 1”), and then again between May and June (“period 2”) and June and July 2020 (“period 3”). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. Results: The impact of the pandemic continued to be felt well after countries’ first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. Conclusion: Centres reported a broad return of services approaching pre-pandemic “normal” by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries.

Published
2022
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10. Association between carotid plaque vulnerability and high mobility group box-1 serum levels in a diabetic population

Author

Federico Biscetti, Giovanni Tinelli, Maria Margherita Rando, Elisabetta Nardella, Andrea Leonardo Cecchini, Flavia Angelini, Giuseppe Straface, Marco Filipponi, Vincenzo Arena, Dario Pitocco, Antonio Gasbarrini, Massimo Massetti, and Andrea Flex

Subjects
Diabetes mellitus, Internal carotid artery stenosis (ICAS), High mobility group box-1 (HMGB1), Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background Carotid atherosclerosis represents one of the complications of diabetes mellitus. In particular, plaque instability contributes to disease progression and stroke incidence. High mobility group box-1 (HMGB1) is a nuclear protein involved in promotion and progression of atherosclerosis and cardiovascular diseases. The aim of this study was to analyze the relationship between HMGB1 serum levels, main inflammatory cytokines, the presence of internal carotid stenosis and unstable plaque in a diabetic population. Research design and methods We studied 873 diabetic patients, including 347 patients with internal carotid artery stenosis (ICAS) who underwent carotid endarterectomy and 526 diabetic patients without internal carotid artery stenosis (WICAS). At baseline, HMGB1 and the main inflammatory cytokines serum levels were evaluated. For ICAS patients, the histological features of carotid plaque were also collected to differentiate them in patients with stable or unstable atherosclerotic lesions. Results We found that HMGB1 serum levels, osteoprotegerin, high-sensitivity C-reactive protein, tumor necrosis factor-alpha and interleukin-6, were significantly higher in diabetic ICAS patients compared to diabetic WICAS patients. Among ICAS patients, individuals with unstable plaque had higher levels of these cytokines, compared to patients with stable plaque. A multivariable stepwise logistic regression analysis showed that HMGB1 and osteoprotegerin remained independently associated with unstable plaque in ICAS patients. Conclusions The present study demonstrated that HMGB1 is an independent risk factor for carotid plaque vulnerability in an Italian population with diabetes mellitus, representing a promising biomarker of carotid plaque instability and a possible molecular target to treat unstable carotid plaques and to prevent stroke.

Published
2021
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11. TEVAR for traumatic thoracic injury with the first-generation stent graft

Author

Giovanni Tinelli, MD, PhD, Fabrizio Minelli, MD, Simona Sica, MD, Francesca De Nigris, MD, Massimo Massetti, MD, and Yamume Tshomba, MD

Subjects
Thoracic endovascular aortic repair, Thoracic aortic injury, Thoracic aorta, Personalized medicine, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Thoracic endovascular aortic repair (TEVAR) is a life-saving treatment for blunt thoracic aortic injury. We report long-term outcomes of two young patients who underwent TEVAR for blunt thoracic aortic injury with first-generation thoracic stent grafts. The off-label use of the endograft affected the outcomes: one case of open surgery conversion due to an aortoesophageal fistula and one case of endovascular relining for a voluminous pseudoaneurysm associated with a type III endoleak. Long-term follow-up is crucial in TEVAR, especially in case of a first-generation device used in an urgent setting.

Published
2021
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12. Long-term follow-up of adventitial cyst surgical excision in external iliac vein

Author

Giovanni Tinelli, MD, PhD, Francesca Montanari, MD, Fabrizio Minelli, MD, Francesca De Nigris, MD, Simona Sica, MD, and Yamume Tshomba, MD

Subjects
Adventitial cystic disease, Venous cyst, External iliac vein, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Adventitial cystic disease of the venous system is an extremely rare condition. Forty-five cases have been described in the literature during the last 70 years, but they may not be representative of the real incidence of this pathologic process. We report a case of an adventitial cyst compressing the right external iliac vein and presenting with edema of the ipsilateral leg. Ultrasound imaging and computed tomography angiography showed the typical features of cystic disease and venous stenosis. Cyst excision was performed with a double surgical access. No perioperative complications were reported. There was no recurrence at 4-year follow-up.

Published
2020
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13. 'Redo' 2D–3D Fusion Technique during Endovascular Redo Aortic Repair

Author

Fabrizio Minelli, Simona Sica, Fadia Salman, Federica Donato, May Dvir, Yamume Tshomba, and Giovanni Tinelli

Subjects
endovascular procedures, redo aortic endovascular surgery, fusion imaging, redo fusion imaging, personalized medicine, Medicine (General), R5-920
Abstract

Purpose: The present study aims to describe a new 2D–3D fusion registration method in the case of endovascular redo aortic repair and compare the accuracy of the registration using the previously implanted devices vs. bones as landmarks. Materials and Methods: This single-center study prospectively analyzed all the patients that underwent elective endovascular re-interventions using the Redo Fusion technique between January 2016 and December 2021 at the Vascular Surgery Unit of the Fondazione Policlinico Universitario A. Gemelli (FPUG)—IRCCS in Rome, Italy. The fusion overlay was performed twice, first using bone landmarks (bone fusion) and the second using radiopaque markers of a previous endovascular device (redo fusion). The pre-operative 3D model was fused with live fluoroscopy to create a roadmap. Longitudinal distances between the inferior margin of the target vessel in live fluoroscopy and the inferior margin of the target vessel in bone fusion and redo fusion were measured. Results: This single-center study prospectively analyzed 20 patients. There were 15 men and five women, with a median age of 69.7 (IQR 42) years. The median distance between the inferior margin of the target vessel ostium in digital subtraction angiography and the inferior margin of the target vessel ostium in bone fusion and redo fusion was 5.35 mm and 1.35 mm, respectively (p ≤ 0.0001). Conclusions: The redo fusion technique is accurate and allows the optimization of X-ray working views, supporting the endovascular navigation and vessel catheterization in case of endovascular redo aortic repair.

Published
2023
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14. Endoanchors under 3D image fusion for a type IA endoleak after EVAR

Author

Giovanni Tinelli, Francesca De Nigris, Fabrizio Minelli, Roberto Flore, Angelo Santoliquido, and Yamume Tshomba

Subjects
endoanchors, fusion imaging, innovative biotechnologies, personalized medicine, Medicine, Medicine (General), R5-920
Abstract

Key Clinical Message The Heli‐FX technique for type IA EL under 3D‐IF proved to be accurate in terms of EL channel vision and correct endoanchors deployment. The EL volume rendering constant view allowed a precise anchors fixation at the EL channel. 3D‐IF confirmed to be a valid help in orientation and navigation during endovascular aortic procedure.

Published
2019
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15. Open conversion after Nellix endovascular aneurysm sealing

Author

Giovanni Tinelli, MD, PhD, Francesco Alberto Codispoti, MD, Simona Sica, MD, Fabrizio Minelli, MD, Francesca De Nigris, MD, and Yamume Tshomba, MD

Subjects
Nellix, Endovascular aneurysm sealing (EVAS), Open conversion, Personalized medicine, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

The Nellix endovascular aneurysm sealing system (Endologix, Irvine, Calif) was presented as a novel concept in the treatment of abdominal aortic aneurysm. After numerous adverse events, the device was voluntarily withdrawn from the market by the manufacturer. This video describes the technical approach of a successful explantation of the Nellix endograft in a patient who underwent endovascular aneurysm sealing for abdominal aortic aneurysm.

Published
2020
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16. Correction to: Association between carotid plaque vulnerability and high mobility group box‑1 serum levels in a diabetic population

Author

Federico Biscetti, Giovanni Tinelli, Maria Margherita Rando, Elisabetta Nardella, Andrea Leonardo Cecchini, Flavia Angelini, Giuseppe Straface, Marco Filipponi, Vincenzo Arena, Dario Pitocco, Antonio Gasbarrini, Massimo Massetti, and Andrea Flex

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Published
2021
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17. Serum high mobility group box-1 and osteoprotegerin levels are associated with peripheral arterial disease and critical limb ischemia in type 2 diabetic subjects

Author

Silvia Giovannini, Giovanni Tinelli, Federico Biscetti, Giuseppe Straface, Flavia Angelini, Dario Pitocco, Luciana Mucci, Raffaele Landolfi, and Andrea Flex

Subjects
HMGB-1, OPG, PAD, Type 2 diabetes, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background High mobility group box-1 (HMGB-1) is a nuclear protein also acting as inflammatory mediator, whilst osteoprotegerin (OPG), member of tumor necrosis factor receptor superfamily, is indicated as marker of vascular calcification. Peripheral artery disease (PAD) and type 2 diabetes (T2D) are clinical conditions characterized by elevated serum inflammatory markers and vascular calcification enhancement. The aim of this study was to investigate the potential role of HMGB-1, OPG and several inflammatory mediators such as C-reactive protein (HsCRP), tumor necrosis factor-alpha and interleukin-6 (IL-6) on the presence and severity of peripheral artery disease in patients with T2D. Methods In this retrospective observational study, we have analyzed HMGB-1, OPG and inflammatory cytokines serum levels in 1393 type 2 diabetic patients with PAD and without PAD (WPAD). Results HMGB-1 (7.89 ± 15.23 ng/mL), OPG (6.54 ± 7.76 pmol/L), HsCRP (15.6 ± 14.4 mg/L) and IL-6 (56.1 ± 28.6 pg/mL) serum levels were significantly higher in patients with PAD than in those WPAD (3.02 ± 8.12 ng/mL, P ˂ 0.001; 2.98 ± 2.01 pmol/L, P

Published
2017
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19. International Multi-Institutional Experience with Presentation and Management of Aortic Arch Laterality in Aberrant Subclavian Artery and Kommerell’s Diverticulum

Author

Clare Moffatt, Jonathan Bath, Richard T. Rogers, Jill J. Colglazier, Drew J. Braet, Dawn M. Coleman, Salvatore T. Scali, Martin R. Back, Gregory A. Magee, Anastasia Plotkin, Philip Dueppers, Alexander Zimmermann, Rana O. Afifi, Sophia Khan, Devin Zarkowsky, Gregory Dyba, Michael C. Soult, Kevin Mani, Anders Wanhainen, Carlo Setacci, Massimo Lenti, Loay S. Kabbani, Mitchell R. Weaver, Daniele Bissacco, Santi Trimarchi, Jordan B. Stoecker, Grace J. Wang, Zoltan Szeberin, Eniko Pomozi, Hugh A. Gelabert, Shahed Tish, Andrew W. Hoel, Nicholas S. Cortolillo, Emily L. Spangler, Marc A. Passman, Giovanni De Caridi, Filippo Benedetto, Wei Zhou, Yousef Abuhakmeh, Daniel H. Newton, Christopher M. Liu, Giovanni Tinelli, Yamume Tshomba, Airi Katoh, Sammy S. Siada, Manar Khashram, Sinead Gormley MBBCH, John R. Mullins, Zachary C. Schmittling, Thomas S. Maldonado, Amani D. Politano, Pawel Rynio, Arkadiusz Kazimierczak, Alexander Gombert, Houman Jalaie, Paolo Spath, Enrico Gallitto, Martin Czerny, Tim Berger, Mark G. Davies, Francesco Stilo, Nunzio Montelione, Luca Mezzetto, Gian Franco Veraldi, Mario D'Oria, Sandro Lepidi, Peter Lawrence, and Karen Woo

Subjects
Surgery, General Medicine, Cardiology and Cardiovascular Medicine
Published
2023
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20. In situ reconstruction of distal renal artery aneurysm with renal perfusion: A case series

Author

Montanari, Francesca, Tinelli, Giovanni, Romagnoli, Jacopo, Donato, Federica, Minelli, Fabrizio, Donati, Tommaso, Tshomba, Yamume, Giovanni Tinelli (ORCID:0000-0002-2212-3226), Jacopo Romagnoli (ORCID:0000-0002-7153-0346), Federica Donato, Fabrizio Minelli, Tommaso Donati (ORCID:0000-0002-4484-2176), Yamume Tshomba (ORCID:0000-0001-7304-7553), Montanari, Francesca, Tinelli, Giovanni, Romagnoli, Jacopo, Donato, Federica, Minelli, Fabrizio, Donati, Tommaso, Tshomba, Yamume, Giovanni Tinelli (ORCID:0000-0002-2212-3226), Jacopo Romagnoli (ORCID:0000-0002-7153-0346), Federica Donato, Fabrizio Minelli, Tommaso Donati (ORCID:0000-0002-4484-2176), and Yamume Tshomba (ORCID:0000-0001-7304-7553)

Abstract

The treatment of renal artery aneurysms located from the mid to distal portion of the vessel is challenging. The complexity is related to the frequent involvement of side branches and to the risk of postoperative renal impairment. We report five cases of multidisciplinary treatment of distal renal artery aneurysms, adopting in situ reconstruction technique and renal perfusion with Custodiol solution, with satisfactory early and mid-term outcomes.

Published
2023

22. Images in Vascular Medicine: Intravascular lipoma of a common femoral vein - an uncommon cause of recurrent deep vein thrombosis

Author

Federica, Donato, Pierfrancesco Antonio, Annuvolo, Andrea, Lupascu, Tommaso, Donati, Giovanni, Tinelli, and Yamume, Tshomba

Subjects
Venous Thrombosis, vein, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Cardiology, Humans, image, personalized medicine, Femoral Vein, Cardiology and Cardiovascular Medicine, vascular surgery, Settore MED/22 - CHIRURGIA VASCOLARE
Published
2022
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23. Long-Term Propensity-Matched Comparison of Fenestrated Endovascular Aneurysm Repair and Open Surgical Repair of Complex Abdominal Aortic Aneurysms

Author

Giovanni Tinelli, Simona Sica, Jonathan Sobocinski, Zoé Ribreau, Chiara de Waure, Marco Ferraresi, Francesco Snider, Yamume Tshomba, Stéphan Haulon, Università cattolica del Sacro Cuore = Catholic University of the Sacred Heart [Roma] (Unicatt), 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), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Università degli Studi di Perugia = University of Perugia (UNIPG), Università degli Studi di Milano = University of Milan (UNIMI), and Hôpital Marie-Lannelongue

Subjects
[SDV]Life Sciences [q-bio], FEVAR, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Radiology, Nuclear Medicine and imaging, Surgery, personalized medicine, BEVAR, Cardiology and Cardiovascular Medicine, complex abdominal aortic aneurysm, Settore MED/22 - CHIRURGIA VASCOLARE, open repair
Abstract

Purpose: This study investigated the long-term outcomes of patients treated with fenestrated and branched endovascular aneurysm repair (F-BEVAR) or open surgical repair (OSR) for complex abdominal aortic aneurysms (c-AAAs). Complex abdominal aortic aneurysms are defined as aneurysms that involve the renal or mesenteric arteries and extend up to the level of the celiac axis or diaphragmatic hiatus but do not extend into the thoracic aorta. This study compares with a propensity-score matching the outcome of these procedures from 2 high-volume aortic centers. Materials and Methods: All patients with c-AAAs undergoing repair at 2 centers between January 2010 and June 2016 were included. The long-term imaging follow-up consisted in a yearly computed tomography angiography (CTA) in the F-BEVAR group. Yearly abdominal ultrasound examination and 5-year CTA were performed in the OSR group. The primary endpoints were long-term mortality, aneurysm-related mortality, and chronic renal decline (CRD), defined as estimated glomerular filtration rate reduction to 2 or >20%/de novo dependence on permanent dialysis in patients with normal or abnormal preoperative renal function, respectively. Secondary endpoints included aortic-related reinterventions, target vessel occlusion, proximal aorta degeneration, access-related complications, graft infection, and the composite endpoint of clinical failure during follow-up. Results: After 1:1 propensity matching, 102 consecutive patients who underwent F-BEVAR and OSR, respectively, were included. The median follow-up was 67 months. There was no significant difference in long-term overall mortality (40.2% vs 36.3%; p=0.40) and aneurysm-related mortality (6.8% vs 5.8%; p=0.30), in the F-BEVAR and OSR groups, respectively. During follow-up, late renal function decline occurred in 27 (27.8%) versus 46 patients (47.4%) in the F-BEVAR and OSR groups, respectively (pConclusions: No differences in overall and aneurysm-related mortality were observed. Chronic renal decline was significantly higher after OSR, while the reintervention rate was higher in the F-BEVAR group. These long-term results reflect the outcomes of a complex procedure performed by a single experienced operator in 2 high-volume centers, and followed with a strict surveillance imaging follow-up. Clinical Impact Nowadays, F-BEVAR and OSR are considered two established techniques for the treatment of c-AAA. However, long-term comparative outcomes are not well studied, and concerns may rise in terms of durability of the repair, risk of reinterventions and late chronic renal decline. The present study showed, with a median follow-up > 5 years, no differences in overall and aneurysm-related mortality. Chronic renal decline was significantly higher after OSR, while the reintervention rate was higher in the endovascular group. To achieve the best possible long-term outcomes, both techniques should be performed in high volume aortic centres, tailored to the patient, and with an adequate surveillance imaging.

Published
2023
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24. A review of acute limb ischemia in COVID-positive patients

Author

Wissam Al-Jundi, Giovanni Tinelli, Leigh Anne O'Banion, Yana Etkin, Dejah R. Judelson, Aksim G. Rivera, Rafaello Bellosta, Ageliki G. Vouyouka, and Nicole Ilonzo

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Clinical Sciences, 030232 urology & nephrology, Ischemia, Inflammation, Review Article, Disease, Cardiorespiratory Medicine and Haematology, 030204 cardiovascular system & hematology, Cardiovascular, 03 medical and health sciences, Rare Diseases, 0302 clinical medicine, Clinical Research, Internal medicine, medicine, Humans, In patient, Rayleigh-Taylor instability, Thrombectomy, business.industry, Anticoagulants, COVID-19, Thrombosis, Hematology, medicine.disease, Settore MED/22 - CHIRURGIA VASCOLARE, Limb ischemia, Mixing efficiency, Good Health and Well Being, Increased risk, Lower Extremity, Cardiovascular System & Hematology, Cardiology, Surgery, Patient Safety, Stratification, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract

This literature review discusses the current evidence on acute limb ischemia (ALI) in patients with COVID-19. Throughout the pandemic, these patients have been at increased risk of arterial thrombotic events and subsequent mortality as a result of a hypercoagulable state. The exact mechanism of thrombosis is unknown; however arterial thrombosis may be due to invasion of endothelial cells via angiotensin-converting enzyme 2 (ACE2) receptors, endothelial injury from inflammation, or even free-floating aortic thrombus. Multiple studies have been performed evaluating the medical and surgical management of these patients; the decision to proceed with operative intervention is dependent on the patient's clinical status as it relates to COVID-19 and morbidity of that disease. The interventions afforded typically include anticoagulation in patients undergoing palliation; alternatively, thrombectomy (endovascular and open) is utilized in other patients. There is a high risk of rethrombosis, despite anticoagulation, given persistent endothelial injury from the virus. Postoperative mortality can be high in these patients.

Published
2021
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25. Association between carotid plaque vulnerability and high mobility group box-1 serum levels in a diabetic population

Author

Dario Pitocco, Federico Biscetti, Andrea Flex, Giuseppe Straface, Elisabetta Nardella, Giovanni Tinelli, Maria Margherita Rando, Massimo Massetti, Antonio Gasbarrini, Flavia Angelini, Vincenzo Arena, Andrea Leonardo Cecchini, and Marco Filipponi

Subjects
Male, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Carotid endarterectomy, 030204 cardiovascular system & hematology, 0302 clinical medicine, Settore BIO/12 - BIOCHIMICA CLINICA E BIOLOGIA MOLECOLARE CLINICA, Diabetes mellitus, Risk Factors, Carotid Stenosis, HMGB1 Protein, Stroke, Original Investigation, 0303 health sciences, education.field_of_study, Prognosis, Settore MED/22 - CHIRURGIA VASCOLARE, Plaque, Atherosclerotic, C-Reactive Protein, Italy, Cardiology, cardiovascular system, Female, Inflammation Mediators, Cardiology and Cardiovascular Medicine, Internal carotid artery stenosis (ICAS), medicine.medical_specialty, Population, Risk Assessment, High mobility group box-1 (HMGB1), 03 medical and health sciences, Osteoprotegerin, Internal medicine, medicine, Humans, Diseases of the circulatory (Cardiovascular) system, Risk factor, education, 030304 developmental biology, Angiology, Aged, Rupture, Spontaneous, business.industry, Interleukin-6, Tumor Necrosis Factor-alpha, Correction, medicine.disease, Stenosis, Diabetes Mellitus, Type 2, Case-Control Studies, RC666-701, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, business, Biomarkers
Abstract

Background Carotid atherosclerosis represents one of the complications of diabetes mellitus. In particular, plaque instability contributes to disease progression and stroke incidence. High mobility group box-1 (HMGB1) is a nuclear protein involved in promotion and progression of atherosclerosis and cardiovascular diseases. The aim of this study was to analyze the relationship between HMGB1 serum levels, main inflammatory cytokines, the presence of internal carotid stenosis and unstable plaque in a diabetic population. Research design and methods We studied 873 diabetic patients, including 347 patients with internal carotid artery stenosis (ICAS) who underwent carotid endarterectomy and 526 diabetic patients without internal carotid artery stenosis (WICAS). At baseline, HMGB1 and the main inflammatory cytokines serum levels were evaluated. For ICAS patients, the histological features of carotid plaque were also collected to differentiate them in patients with stable or unstable atherosclerotic lesions. Results We found that HMGB1 serum levels, osteoprotegerin, high-sensitivity C-reactive protein, tumor necrosis factor-alpha and interleukin-6, were significantly higher in diabetic ICAS patients compared to diabetic WICAS patients. Among ICAS patients, individuals with unstable plaque had higher levels of these cytokines, compared to patients with stable plaque. A multivariable stepwise logistic regression analysis showed that HMGB1 and osteoprotegerin remained independently associated with unstable plaque in ICAS patients. Conclusions The present study demonstrated that HMGB1 is an independent risk factor for carotid plaque vulnerability in an Italian population with diabetes mellitus, representing a promising biomarker of carotid plaque instability and a possible molecular target to treat unstable carotid plaques and to prevent stroke.

Published
2021

26. A multicenter 'real-world' study of the valiant NAVION stent graft

Author

Claudio Gandarias, Gabriele Pagliaricco, Giulio Accarino, Giancarlo Accarino, Theodoros Kratimenos, Giovanni Tinelli, Francesca De Nigris, Davide Pacini, Dimitrios Tomais, Andrés Reyes-Valdivia, Sara Schiavon, Fabrizio Minelli, Luigi Lovato, Simona Sica, Yamume Tshomba, Emanuele Gatta, Marco Ferraresi, Valvidia A.R., Kratimenos T., Ferraresi M., Sica S., Lovato L., Accarino G., Pagliaricco G., Tshomba Y., Tinelli G., Gandarias C., Pacini D., Tomais D., Gatta E., Schiavon S., Minelli F., and De Nigris F.

Subjects
medicine.medical_specialty, medicine.medical_treatment, 030204 cardiovascular system & hematology, Prosthesis Design, vascular surgery, law.invention, New onset, Blood Vessel Prosthesis Implantation, 03 medical and health sciences, 0302 clinical medicine, vascular, Thoracic stent graft, law, medicine, Humans, 030212 general & internal medicine, Adverse effect, Retrospective Studies, Aortic Aneurysm, Thoracic, business.industry, Incidence (epidemiology), Mortality rate, Endovascular Procedures, Stent, Settore MED/22 - CHIRURGIA VASCOLARE, Personalized medicine, Intensive care unit, Blood Vessel Prosthesis, Surgery, Treatment Outcome, Multicenter study, Early results, Innovative biotechnologie, graft, Navion stent graft, Stents, Low-profile thoracic stent graft, Cardiology and Cardiovascular Medicine, business
Abstract

Background The aim of the present study was to evaluate early results of thoracic endovascular aortic repair (TEVAR) using the Valiant Navion™ stent graft in a “real-world” scenario. Methods All patients who underwent TEVAR with the Valiant Navion™ endograft between November 2018 and November 2019 were included in this retrospective multicenter study (six European centers). The primary endpoints were technical success, incidence of major adverse events (MAEs), access failure, deployment failure, deployment accuracy, and rate of intraoperative endoleaks (ELs). Results One hundred-sixteen patients with varying thoracic aortic diseases were included. Eighteen patients (15.5%) were treated for an off-label condition. The technical success rate was 100%, without any access or deployment failures. The proximal and distal deployment accuracy rates were 99.1% and 97.4%, respectively. There were no intraoperative MAEs, including death. Two (1.7%) type Ib ELs were detected at the first postoperative CTA, all of which were in off-label procedures and related to the short length of the sealing neck. No type III ELs were detected. The median hospitalization time was 8 days (IQR 4–12), including a median intensive care unit stay of 1 day (IQR 1–2). The in-hospital mortality rate was 4.3%. At a median follow-up time of 98 days (IQR 39–187), there were no aortic-related mortalities or new onset of endoleaks. Conclusion Our initial experience with the Valiant Navion™ endograft in a wide variety of aortic diseases showed safe early outcomes, especially for on-label procedures.

Published
2021
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27. Contemporary outcomes after treatment of aberrant subclavian artery and Kommerell's diverticulum

Author

Jonathan Bath, Mario D'Oria, Richard T. Rogers, Jill J. Colglazier, Drew J. Braet, Dawn M. Coleman, Salvatore T. Scali, Martin R. Back, Gregory A. Magee, Anastasia Plotkin, Philip Dueppers, Alexander Zimmermann, Rana O. Afifi, Sophia Khan, Devin Zarkowsky, Gregory Dyba, Michael C. Soult, Kevin Mani, Anders Wanhainen, Carlo Setacci, Massimo Lenti, Loay S. Kabbani, Mitchelle R. Weaver, Daniele Bissacco, Santi Trimarchi, Jordan B. Stoecker, Grace J. Wang, Zoltan Szeberin, Eniko Pomozi, Clare Moffatt, Hugh A. Gelabert, Shahed Tish, Andrew W. Hoel, Nicholas S. Cortolillo, Emily L. Spangler, Marc A. Passman, Giovanni De Caridi, Filippo Benedetto, Wei Zhou, Yousef Abuhakmeh, Daniel H. Newton, Christopher M. Liu, Giovanni Tinelli, Yamume Tshomba, Airi Katoh, Sammy S. Siada, Manar Khashram, Sinead Gormley, John R. Mullins, Zachary C. Schmittling, Thomas S. Maldonado, Amani D. Politano, Pawel Rynio, Arkadiusz Kazimierczak, Alexander Gombert, Houman Jalaie, Paolo Spath, Enrico Gallitto, Martin Czerny, Tim Berger, Mark G. Davies, Francesco Stilo, Nunzio Montelione, Luca Mezzetto, Gian Franco Veraldi, Sandro Lepidi, Peter Lawrence, and Karen Woo

Subjects
Aberrant subclavian artery, Kommerell's diverticulum, Surgery, Cardiology and Cardiovascular Medicine, Settore MED/22 - CHIRURGIA VASCOLARE
Published
2023
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28. 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
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29. Synchronous Partial Nephrectomy and Renal Artery Aneurysm Repair in Bilateral Renal Cancers: Case Report and Literature Review

Author

Yamume Thsomba, Domenico Nigro, Nazario Foschi, Pierfrancesco Bassi, Luca Di Gianfrancesco, Mauro Ragonese, Pierluigi Russo, Giovanni Tinelli, and Simona Sica

Subjects
Male, medicine.medical_specialty, Urology, medicine.medical_treatment, Renal function, urologic and male genital diseases, Nephrectomy, Renal artery aneurysm, Renal Artery, Aneurysm, medicine.artery, medicine, Partial nephrectomy, Humans, Renal artery, Aged, Settore MED/06 - ONCOLOGIA MEDICA, Settore MED/24 - UROLOGIA, business.industry, Cancer, Renal cancers, medicine.disease, Settore MED/22 - CHIRURGIA VASCOLARE, Kidney Neoplasms, Surgery, Renal cancer, Radiological weapon, business
Abstract

The treatment of renal cancer has changed in the last decades with an increase in application of conservative surgery such as partial nephrectomy (PN) in order to achieve an optimal oncological outcome with the maximum preservation of renal function. The indication for PN is mandatory in case of bilateral tumors or in case of impaired renal function. Renal artery (RA) aneurysm (RAA) is a rare occurrence, and its treatment could be radiological or surgical according to the anatomy of the aneurysm and the clinical characteristics of the patients. Here, we report a case of simultaneous ipsilateral occurrence of renal cancer and RAA in a patient with bilateral renal masses, treated with 1 surgical procedure with good functional and oncological outcomes. This rare occurrence must be known by surgeons treating renal cancers, and it is possible to perform the 2 procedures in 1 surgical step.

Published
2021
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30. Mid-term outcomes of the use of endoanchors during thoracic endovascular aortic repair in multicentre analysis

Author

Andrés Reyes Valdivia, Ross Milner, Robin Heijmen, Vicente Riambau, Hervé Rousseau, Giovanni Tinelli, Drosos Kotelis, Ahmad A Zanabili Al-Sibbai, Georgios Pitoulias, Claudio Gandarias Zúñiga, Hector W L de Beaufort, Doukas Panagiotis, and Arindam Chaudhuri

Subjects
thoracic endovascular aortic repair, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Radiology, Nuclear Medicine and imaging, Surgery, type I endoleaks, General Medicine, Cardiology and Cardiovascular Medicine, Endoanchors, Settore MED/22 - CHIRURGIA VASCOLARE
Abstract

Objective To describe mid-term outcomes of the use of EndoAnchors as an adjunct for arch and thoracic endovascular aortic repair (TEVAR). Methods A retrospective multicentre series from nine centres using the Heli-FX EndoAnchor System (Medtronic Inc, Minneapolis, USA) at TEVAR over May 2014–May 2019 is presented. The study is registered at ClinicalTrials.gov with number NCT04100499. The primary outcome was freedom from Type I endoleak at EndoAnchors deployments; secondary outcomes included evaluation of aortic wall penetration (AWP) at first computed tomography scan, EndoAnchor-related issues and mortality. Results 54 high-risk patients (35 males/19 females, age 73 ± 11 years) with arch, thoracic and thoracoabdominal aneurysmal disease (3 chronic post-dissection and one patch pseudoaneurysm), with a mean neck length 19.7 ± 6.6 mm that were treated with multiple hybrid and endovascular techniques were included. A total of 329 EndoAnchors were used with a mean of 6.1 ± 2.5 per patient. Overall adequate AWP was 86%, whereas arch (Ishimaru’s zones 0–2) deployments achieved 80.6% when compared to 87.3% in descending thoracic aorta (dTA); although there was no statistical significance. Freedom from type I endoleaks was 88% at 2 year follow-up, due to 4 type IA endoleaks, two of them successfully treated, one with conservative treatment due to complexity of repair and remaining patient died 1 year later due to endograft infection. There were reported five EndoAnchor-related issues; four losses and one renal stent-graft was crushed due to catheter deflection solved with balloon reinflation. None of the losses had clinical significance. Overall mortality is described for 7 (9.5%) patients, one of them aneurysm-related. Conclusions The adjunctive use of EndoAnchors in TEVAR and complex TEVAR procedures achieved acceptable outcomes at midterm in a high-risk series with hostile seal zones. Still, they should be still judiciously used as there is lack of data to suggest a more liberal use; therefore, the landing zone should not be compromised in favour of their use.

Published
2022

31. Endovascular aortic repair with EndoAnchors demonstrate good mid-term outcomes in physician-initiated multicenter analysis-The PERU registry

Author

Michel M.P.J. Reijnen, Giovanni Tinelli, Andrés Reyes Valdivia, Claudio Gandarias, Richte C. L. Schuurmann, Trissa Babrowski, Jean-Paul P.M. de Vries, Giovanni Pratesi, Yamume Tshomba, Arindam Chaudhuri, Ayman Badawy, Matteo Barbante, Georgios A. Pitoulias, Ross Milner, ​Robotics and image-guided minimally-invasive surgery (ROBOTICS), Multi-Modality Medical Imaging, and TechMed Centre

Subjects
Male, type IaEL, medicine.medical_specialty, Endoleak, 030204 cardiovascular system & hematology, Aortic repair, EndoAnchors, ESAR, EVAR, hostile neck anatomy, 03 medical and health sciences, Blood Vessel Prosthesis Implantation, 0302 clinical medicine, Physicians, Peru, Medicine, Humans, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Registries, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Endovascular Procedures, General Medicine, Settore MED/22 - CHIRURGIA VASCOLARE, n/a OA procedure, Surgery, Term (time), Blood Vessel Prosthesis, Treatment Outcome, Female, Cardiology and Cardiovascular Medicine, business, Aortic Aneurysm, Abdominal
Abstract

Objectives We aim to describe real-world outcomes from multicenter data about the efficacy of adjunct Heli-FX EndoAnchor usage in preventing or repairing failures during infrarenal endovascular aneurysm repair (EVAR), so-called EndoSutured-aneurysm-repair (ESAR). Methods The current study has been assigned an identifier (NCT04100499) at the US National Library of Medicine ( https://ClinicalTrials.gov ). It is an observational retrospective study of prospectively collected data from seven vascular surgery departments between June 2010 and December 2019. Patients included in the ANCHOR registry were excluded from this analysis. The decision for the use of EndoAnchors was made by the treating surgeon or multidisciplinary aortic committee according to each center’s practice. Follow-up imaging was scheduled according to each center’s protocol, which necessarily included either abdominal ultrasound or radiography or computed tomographic scan imaging. The main outcomes analyzed were technical success, freedom from type Ia endoleaks (IaEL), all-cause and aneurysm-related mortality, and sac variation and trends evaluated for those with at least six months imaging follow-up. Results Two hundred and seventy-five patients underwent ESAR in participating centers during the study period. After exclusions, 221 patients (184 males, 37 females, mean age 75 ± 8.3 years) were finally included for analysis. Median follow-up for the cohort was 27 (interquartile range 12–48) months. A median 6 (interquartile range 3) EndoAnchors were deployed at ESAR, 175 (79%) procedures were primary and 46 (21%) revision cases, 40 associated with type IaEL. Technical success at operation (initial), 30-day, and overall success were 89, 95.5, and 96.8%, respectively; the 30-day success was higher due to those with subsequent spontaneous proximal endoleak seal. At two years, freedom from type IaEL was 94% for the whole series; 96% and 86% for the primary and revision groups, respectively; whereas freedom from all-cause mortality, aneurysm-related mortality, and reintervention was 89%, 98%, and 87%, respectively. Sac evolution pre-ESAR was 66 ± 15.1 vs. post ESAR 61 ± 17.5 (p Conclusions This real-world registry demonstrates that adjunct EndoAnchor usage at EVAR achieves high rates of freedom from type IaEL at mid-term including in a high number of patients with hostile neck anatomy, with positive trends in sac-size evolution. Further data with longer follow-up may help to establish EndoAnchor usage as a routine adjunct to EVAR, especially in hostile necks.

Published
2022

32. Through-and-through femorofemoral wire retrograde technique for the E-nside precannulated inner branch thoracoabdominal stent graft

Author

Tinelli, Giovanni, Minelli, Fabrizio, Donato, Federica, Sica, Simona, De Nigris, Francesca, Tshomba, Yamume, Giovanni Tinelli (ORCID:0000-0002-2212-3226), Fabrizio Minelli, Federica Donato, Simona Sica, Francesca De Nigris, Yamume Tshomba (ORCID:0000-0001-7304-7553), Tinelli, Giovanni, Minelli, Fabrizio, Donato, Federica, Sica, Simona, De Nigris, Francesca, Tshomba, Yamume, Giovanni Tinelli (ORCID:0000-0002-2212-3226), Fabrizio Minelli, Federica Donato, Simona Sica, Francesca De Nigris, and Yamume Tshomba (ORCID:0000-0001-7304-7553)

Abstract

The E-nside multibranched stent graft (Jotec GmbH, Hechingen, Germany) is the first and only off-the-shelf thoracoabdominal prosthesis with precannulated inner branches. Usually, after the device deployment, target vessel stenting will be facilitated by antegrade inner branch cannulation to retrieve the precannulated guide. In the literature, the use of antegrade access has been associated with the potential risk of cerebral and systemic embolization. Therefore, other retrograde techniques have been described. We have reported a new retrograde approach using a precannulated through-and-through femorofemoral wire technique for target vessel catheterization.

Published
2022

33. Postoperative Intensive Care Management of Aortic Repair

Author

Stefano De Paulis, Gabriella Arlotta, Maria Calabrese, Filippo Corsi, Temistocle Taccheri, Maria Enrica Antoniucci, Lorenzo Martinelli, Francesca Bevilacqua, Giovanni Tinelli, and Franco Cavaliere

Subjects
intensive care management, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Settore MED/41 - ANESTESIOLOGIA, postoperative complications, Medicine (miscellaneous), aortic repair, Settore MED/22 - CHIRURGIA VASCOLARE
Abstract

Vascular surgery patients have multiple comorbidities and are at high risk for perioperative complications. Aortic repair surgery has greatly evolved in recent years, with an increasing predominance of endovascular techniques (EVAR). The incidence of cardiac complications is significantly reduced with endovascular repair, but high-risk patients require postoperative ST-segment monitoring. Open aortic repair may portend a prohibitive risk of respiratory complications that could be a contraindication for surgery. This risk is greatly reduced in the case of an endovascular approach, and general anesthesia should be avoided whenever possible in the case of endovascular repair. Preoperative renal function and postoperative kidney injury are powerful determinants of short- and long-term outcome, so that preoperative risk stratification and secondary prevention are critical tasks. Intraoperative renal protection with selective renal and distal aortic perfusion is essential during open repair. EVAR has lower rates of postoperative renal failure compared to open repair, with approximately half the risk for acute kidney injury (AKI) and one-third of the risk of hemodialysis requirement. Spinal cord ischemia used to be the most distinctive and feared complication of aortic repair. The risk has significantly decreased since the beginning of aortic surgery, with advances in surgical technique and spinal protection protocols, and is lower with endovascular repair. Endovascular repair avoids extensive aortic dissection and aortic cross-clamping and is generally associated with reduced blood loss and less coagulopathy. The intensive care physician must be aware that aortic repair surgery has an impact on every organ system, and the importance of early recognition of organ failure cannot be overemphasized.

Published
2022

34. The role of oncovascular surgery in gynecologic oncology surgery

Author

Matias Jurado, Luis Chiva, Giovanni Tinelli, Juan Luis Alcazar, and Dennis S Chi

Subjects
Oncologists, Settore MED/06 - ONCOLOGIA MEDICA, Genital Neoplasms, Female, Obstetrics and Gynecology, Medical Oncology, vascular surgery, Settore MED/22 - CHIRURGIA VASCOLARE, blood vessels, surgical oncology, Gynecologic Surgical Procedures, Oncology, Humans, Female, Retroperitoneal Neoplasms
Abstract

Oncovascular surgery is a new term used to define tumor resection with simultaneous reconstruction of the great vessels when the tumor infiltrates or firmly adheres to such vessels. The benefit of oncovascular surgery has been widely described in patients with hepato-biliary-pancreatic cancers, retroperitoneal soft tissue sarcoma, and in other areas of gynecologic oncology, such as the lateral compartment of the pelvis, retroperitoneum, and hepato-biliary-pancreatic region, with an increase in complete resections and without increasing the morbidity and mortality rates. In the latter decades of the past century, several advances and accumulating scientific evidence led gynecologic oncologists to perform more thorough cytoreductive surgeries that included multivisceral resections. But to our knowledge, published studies on the frequency and relevance of vascular surgery in gynecological oncology are scarce. Gynecologic oncologists still do not receive formal training in vascular surgery and additionally, with the current reduction in experience with pelvic and para-aortic lymphadenectomy, as well as other types of radical abdominal and pelvic surgeries, trainees will encounter fewer vascular injuries and the opportunity to deal with a variety of management types required. Well-organized collaboration between each subspecialty with a multidisciplinary approach and adequate pre-operative planning are pivotal. The aim of this review is to pave the way towards the understanding that patients with suspicion of great vessels' infiltration or encasement by tumor require personalized and specialized treatment with the need to form an oncovascular surgery team, and that it is necessary for gynecologic oncology surgeons to take a step forward in surgical training.

Published
2022

35. A New Mini-Invasive Approach for a Catastrophic Disease: Staged Endovascular and Endoscopic Treatment of Aorto-Esophageal Fistulas

Author

Federica Donato, Ivo Boskoski, Claudio Vincenzoni, Francesca Montanari, Giovanni Tinelli, Tommaso Donati, and Yamume Tshomba

Subjects
TEVAR, aneurysm, Medicine (miscellaneous), aorto-esophageal fistula, Settore MED/22 - CHIRURGIA VASCOLARE
Abstract

Aorto-esophageal fistula (AEF) is an uncommon but usually fatal disorder. Surgery with resection of an aneurysm and esophagus, in situ reconstruction of the descending aorta and omental flap installation offers the gold standard for the reduction of infections, but it is burdened by high intraoperative and perioperative mortality rates. We report our experience with a combined minimally invasive approach for the multi-stage treatment of three cases of aorto-esophageal fistula caused by thoracic aneurysm rupture. In all of the patients, the aneurysm was treated with thoracic endovascular aortic repair and the esophageal lesion was treated with esophageal endoprosthesis placement. According to our experience, the combined strategy of thoracic endovascular aortic repair (TEVAR) and esophageal less invasive endoscopic treatments represents an alternative solution in frail patients with high surgical risk.

Published
2022

36. Hybrid single-stage repair of kommerell’s diverticulum in a right aortic arch in a patient with 22q11.2 deletion syndrome

Author

Emmanouela Chourda, Carolina Putotto, Paolo Versacci, Sara Saltarocchi, Mizar D’Abramo, Yamume Tshomba, Giovanni Tinelli, and Fabio Miraldi

Subjects
Heart Defects, Congenital, thoracic, cardiovascular abnormalities, diverticulum, digeorge syndrome, congenital, Aorta, Thoracic, General Medicine, Settore MED/22 - CHIRURGIA VASCOLARE, subclavian artery, aorta, kommerell’s diverticulum, surgical procedures, operative, right aortic arch, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, hybrid procedure, aorta, thoracic, humans, treatment outcome, heart defects, congenital, cardiovascular system, heart defects, Surgery, cardiovascular diseases, Cardiology and Cardiovascular Medicine
Abstract

Hybrid single-stage repair of Kommerell’s diverticulum in a right aortic arch. Aortic arch anomalies, isolated or associated with congenital heart defects, are cardiovascular manifestations frequently associated with 22q11.2 deletion syndrome. Kommerell’s diverticulum in the context of a right aortic arch is an exceedingly rare congenital anomaly, consisting in aneurysmal degeneration of the origin of an aberrant left subclavian artery. Open surgical repair has been the treatment paradigm, but in recent years, hybrid and endovascular procedures have also been proposed. In this report we present the case of a patient affected by 22q11.2 deletion syndrome successfully treated for Kommerell’s diverticulum associated with a right-sided aortic arch through a single-stage hybrid procedure, consisting of bilateral carotid-subclavian bypass, exclusion of the diverticulum by an endovascular thoracic stent graft, and aberrant left subclavian artery plug occlusion. This type of hybrid technique can be an excellent alternative to extensive open surgical repairs or when total endovascular repair is deemed unachievable, also in the context of a complex genetic syndrome.

Published
2022

38. Type 1A Endoleak after TEVAR in the Aortic Arch: A Review of the Literature

Author

Lucia Scurto, Nicolò Peluso, Federico Pascucci, Simona Sica, Francesca De Nigris, Marco Filipponi, Fabrizio Minelli, Tommaso Donati, Giovanni Tinelli, and Yamume Tshomba

Subjects
branched graft, TEVAR, fenestrated graft, aortic arch, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, endoleak, Medicine (miscellaneous), chimney, in situ fenestration, Settore MED/22 - CHIRURGIA VASCOLARE
Abstract

Aortic arch repair is a challenging intervention. Open surgical repair is still considered the gold standard, but in high-risk patients, it is not always a reasonable option, making endovascular approaches an enticing, when not the only available, alternative for treatment. The strategies more commonly adopted are surgical supra-aortic trunk (SAT) rerouting followed by deployment of a standard thoracic endoprosthesis, chimney techniques, custom-made scalloped, fenestrated, and branched devices, and in situ or physician-modified fenestrations. If we excluded techniques involving SAT rerouting where the arch anatomy is surgically modified in order to make deployment in the aortic arch of a standard thoracic endoprosthesis possible, in the other techniques, one or more SATs are incorporated in the thoracic endoprosthesis. In these cases, no matter what solution is adopted, because of the morphology of the aorta at this level, achieving an ideal sealing is extremely difficult, and endovascular treatments of the arch are burdened by an increased risk of type IA endoleaks. PubMed, EMBASE, and Cochrane Library were searched. We identified 1277 records. After reading titles, abstracts, and full texts, we excluded 1231 records. Exclusion criteria were low-quality evidence, abstracts, case reports, conference presentations, reviews, editorials, and expert opinions. A total of 48 studies were included, for a total of 3114 patients. A type IA endoleak occurred in 248 patients (7.7%) with a mean incidence of 18.8% in chimney procedures, 4.8% and 3%, respectively, in fenestrated and branched devices, and 2.2% in in situ fenestration. We excluded from our analysis scalloped technology that is used when the target vessel originates from a healthy landing zone and represents a different anatomical setting. Type IA endoleaks are a concern with all types of endovascular aortic arch repair, and they can compromise the outcomes of the procedure. The rate of type IA endoleaks appears to be significantly higher in chimney procedures. In order to maximize sealing, whenever possible, endovascular repair of the arch should be achieved with custom-made fenestrated devices. However, chimney configurations are still a valuable solution particularly in the emergency setting, although in such a procedure, to guarantee accurate postoperative management and follow-up, an imaging protocol could be useful.

Published
2022
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40. Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy

Author

Alison Halliday, Richard Bulbulia, Leo H Bonati, Johanna Chester, Andrea Cradduck-Bamford, Richard Peto, Hongchao Pan, John Potter, Hans Henning Eckstein, Barbara Farrell, Marcus Flather, Averil Mansfield, Boby Mihaylova, Kazim Rahimi, David Simpson, Dafydd Thomas, Peter Sandercock, Richard Gray, Andrew Molyneux, Cliff P Shearman, Peter Rothwell, Anna Belli, Will Herrington, Parminder Judge, Peter Leopold, Marion Mafham, Michael Gough, Piergiorgio Cao, Sumaira MacDonald, Vasha Bari, Clive Berry, S Bradshaw, Wojciech Brudlo, Alison Clarke, Robin Cox, Susan Fathers, Kamran Gaba, Mo Gray, Elizabeth Hayter, Constance Holliday, Rijo Kurien, Michael Lay, Steffi le Conte, Jessica McManus, Zahra Madgwick, Dylan Morris, Andrew Munday, Sandra Pickworth, Wiktor Ostasz, Michiel Poorthuis, Sue Richards, Louisa Teixeira, Sergey Tochlin, Lynda Tully, Carol Wallis, Monique Willet, Alan Young, Renato Casana, Chiara Malloggi, Andrea Odero Jr, Vincenzo Silani, Gianfranco Parati, Giuseppe Malchiodi, Giovanni Malferrari, Francesco Strozzi, Nicola Tusini, Enrico Vecchiati, Gioacchino Coppi, Antonio Lauricella, Roberto Moratto, Roberto Silingardi, Jessica Veronesi, Andrea Zini, Emanuele Ferrero, Michelangelo Ferri, Andrea Gaggiano, Carmelo Labate, Franco Nessi, Daniele Psacharopulo, Andrea Viazzo, Giovanni Malacrida, Daniela Mazzaccaro, Giovanni Meola, Alfredo Modafferi, Giovanni Nano, Maria Teresa Occhiuto, Paolo Righini, Silvia Stegher, Stefano Chiarandini, Filippo Griselli, Sandro Lepidi, Fabio Pozzi Mucelli, Marcello Naccarato, Mario D'Oria, Barbara Ziani, Andrea Stella, Mortalla Dieng, Gianluca Faggioli, Mauro Gargiulo, Sergio Palermo, Rodolfo Pini, Giovanni Maria Puddu, Andrea Vacirca, Domenico Angiletta, Claudio Desantis, Davide Marinazzo, Giovanni Mastrangelo, Guido Regina, Raffaele Pulli, Paolo Bianchi, Lea Cireni, Elisabetta Coppi, Rocco Pizzirusso, Filippo Scalise, Giovanni Sorropago, Valerio Tolva, Valeria Caso, Enrico Cieri, Paola DeRango, Luca Farchioni, Giacomo Isernia, Massimo Lenti, Gian Battista Parlani, Guglielmo Pupo, Grazia Pula, Gioele Simonte, Fabio Verzini, Federico Carimati, Maria Luisa Delodovici, Federico Fontana, Gabriele Piffaretti, Matteo Tozzi, Efrem Civilini, Giorgio Poletto, Bernhard Reimers, Barbara Praquin, Sonia Ronchey, Laura Capoccia, Wassim Mansour, Enrico Sbarigia, Francesco Speziale, Pasqualino Sirignano, Danilo Toni, Roberto Galeotti, Vincenzo Gasbarro, Francesco Mascoli, Tiberio Rocca, Elpiniki Tsolaki, Giulia Bernardini, Ester DeMarco, Alessia Giaquinta, Francesco Patti, Massimiliano Veroux, Pierfrancesco Veroux, Carla Virgilio, Nicola Mangialardi, Matteo Orrico, Vincenzo Di Lazzaro, Nunzio Montelione, Francesco Spinelli, Francesco Stilo, Carlo Cernetti, Sandro Irsara, Giuseppe Maccarrone, Diego Tonello, Adriana Visonà, Beniamino Zalunardo, Emiliano Chisci, Stefano Michelagnoli, Nicola Troisi, Maela Masato, Massimo Dei Negri, Andrea Pacchioni, Salvatore Saccà, Giovanni Amatucci, Alfredo Cannizzaro, Federico Accrocca, Cesare Ambrogi, Renzo Barbazza, Giustino Marcucci, Andrea Siani, Guido Bajardi, Giovanni Savettieri, Angelo Argentieri, Riccardo Corbetta, Attilio Odero, Pietro Quaretti, Federico Z Thyrion, Alessandro Cappelli, Domenico Benevento, Gianmarco De Donato, Maria Agnese Mele, Giancarlo Palasciano, Daniela Pieragalli, Alessandro Rossi, Carlo Setacci, Francesco Setacci, Domenico Palombo, Maria Cecilia Perfumo, Edoardo Martelli, Aldo Paolucci, Santi Trimarchi, Viviana Grassi, Luigi Grimaldi, Giuliana La Rosa, Domenico Mirabella, Matteo Scialabba, Leonildo Sichel, Costantino L D'Angelo, Gian Franco Fadda, Holta Kasemi, Mario Marino, Francesco Burzotta, Francesco Alberto Codispoti, Angela Ferrante, Giovanni Tinelli, Yamume Tshomba, Claudio Vincenzoni, Deborah Amis, Dawn Anderson, Martin Catterson, Mike Clarke, Michelle Davis, Anand Dixit, Alexander Dyker, Gary Ford, Ralph Jackson, Sreevalsan Kappadath, David Lambert, Tim Lees, Stephen Louw, James McCaslin, Noala Parr, Rebecca Robson, Gerard Stansby, Lucy Wales, Vera Wealleans, Lesley Wilson, Michael Wyatt, Hardeep Baht, Ibrahim Balogun, Ilse Burger, Tracy Cosier, Linda Cowie, Gunaratnam Gunathilagan, David Hargroves, Robert Insall, Sally Jones, Hannah Rudenko, Natasha Schumacher, Jawaharlal Senaratne, George Thomas, Audrey Thomson, Tom Webb, Ellen Brown, Bernard Esisi, Ali Mehrzad, Shane MacSweeney, Norman McConachie, Alison Southam, Wayne Sunman, Ahmed Abdul-Hamiq, Jenny Bryce, Ian Chetter, Duncan Ettles, Raghuram Lakshminarayan, Kim Mitchelson, Christopher Rhymes, Graham Robinson, Paul Scott, Alison Vickers, Ray Ashleigh, Stephen Butterfield, Ed Gamble, Jonathan Ghosh, Charles N McCollum, Mark Welch, Sarah Welsh, Leszek Wolowczyk, Mary Donnelly, Stephen D'Souza, Anselm A Egun, Bindu Gregary, Thomas Joseph, Christine Kelly, Shuja Punekar, M Asad Rahi, Sonia Raj, Dare Seriki, George Thomson, James Brown, Ragunath Durairajan, Iris Grunwald, Paul Guyler, Paula Harman, Matthew Jakeways, Christopher Khuoge, Ashish Kundu, Thayalini Loganathan, Nisha Menon, Raji O Prabakaran, Devesh Sinha, Vicky Thompson, Sharon Tysoe, Dennis Briley, Chris Darby, Linda Hands, Dominic Howard, Wilhelm Kuker, Ursula Schulz, Rachel Teal, David Barer, Andrew Brown, Susan Crawford, Paul Dunlop, Ramesh Krishnamurthy, Nikhil Majmudar, Duncan Mitchell, Min P Myint, Richard O'Brien, Janice O'Connell, Naweed Sattar, Shanmugam Vetrivel, Jonathan Beard, Trevor Cleveland, Peter Gaines, John Humphreys, Alison Jenkins, Craig King, Daniel Kusuma, Ralph Lindert, Robbie Lonsdale, Raj Nair, Shah Nawaz, Faith Okhuoya, Douglas Turner, Graham Venables, Paul Dorman, Andrea Hughes, Deborah Jones, David Mendelow, Helen Rodgers, Aidas Raudoniitis, Peter Enevoldson, Hans Nahser, Imelda O'Brien, Francesco Torella, Dave Watling, Richard White, Pauline Brown, Dipankar Dutta, Lorraine Emerson, Paula Hilltout, Sachin Kulkarni, Jackie Morrison, Keith Poskitt, Fiona Slim, Sarah Smith, Amanda Tyler, Joanne Waldron, Mark Whyman, Milda Bajoriene, Lucy Baker, Amanda Colston, Bekky Eliot-Jones, Gita Gramizadeh, Catherine Lewis-Clarke, Laura McCafferty, Deborah Oliver, Debbie Palmer, Abhijeet Patil, Suzannah Pegler, Gopi Ramadurai, Aisling Roberts, Tracey Sargent, Shivaprasad Siddegowda, Ravi Singh-Ranger, Akintunde Williams, Lucy Williams, Steve Windebank, Tadas Zuromskis, Lanka Alwis, Jane Angus, Asaipillai Asokanathan, Caroline Fornolles, Diana Hardy, Sophy Hunte, Frances Justin, Duke Phiri, Marie Mitabouana-Kibou, Lakshmanan Sekaran, Sakthivel Sethuraman, Margaret L Tate, Joyce Akyea-Mensah, Stephen Ball, Angela Chrisopoulou, Elizabeth Keene, Alison Phair, Steven Rogers, John V Smyth, Colin Bicknell, Jeremy Chataway, Nicholas Cheshire, Andrew Clifton, Caroline Eley, Richard Gibbs, Mohammad Hamady, Beth Hazel, Alex James, Michael Jenkins, Nyma Khanom, Austin Lacey, Maz Mireskandari, Joanna O'Reilly, Antony Pereira, Tina Sachs, John Wolfe, Philip Davey, Gill Rogers, Gemma Smith, Gareth Tervit, Ian Nichol, Andrew Parry, Gavin Young, Simon Ashley, James Barwell, Francis Dix, Azlisham M Nor, Chris Parry, Angela Birt, Paul Davies, Jim George, Anne Graham, Leon Jonker, Nicci Kelsall, Caroline Potts, Toni Wilson, Jamie Crinnion, Larissa Cuenoud, Nikola Aleksic, Srdan Babic, Nenad Ilijevski, Đorde Radak, Dragan Sagic, Slobodan Tanaskovic, Momcilo Colic, Vladimir Cvetic, Lazar Davidovic, Dejana R Jovanovic, Igor Koncar, Perica Mutavdžic, Miloš Sladojevic, Ivan Tomic, Eike S Debus, Ulrich Grzyska, Dagmar Otto, Götz Thomalla, Jessica Barlinn, Johannes Gerber, Kathrin Haase, Christian Hartmann, Stefan Ludwig, Volker Pütz, Christian Reeps, Christine Schmidt, Norbert Weiss, Sebastian Werth, Simon Winzer, Janine Gemper, Albrecht Günther, Bianka Heiling, Elisabeth Jochmann, Panagiota Karvouniari, Carsten Klingner, Thomas Mayer, Julia Schubert, Friederike Schulze-Hartung, Jürgen Zanow, Yvonne Bausback, Franka Borger, Spiridon Botsios, Daniela Branzan, Sven Bräunlich, Henryk Hölzer, Janin Lenzer, Christopher Piorkowski, Nadine Richter, Johannes Schuster, Dierk Scheinert, Andrej Schmidt, Holger Staab, Matthias Ulrich, Martin Werner, Hermann Berger, Gábor Biró, Hans-Henning Eckstein, Michael Kallmayer, Kornelia Kreiser, Alexander Zimmermann, Bärbel Berekoven, Klaus Frerker, Vera Gordon, Giovanni Torsello, Sebastian Arnold, Cora Dienel, Martin Storck, Bernhard Biermaier, Hans Martin Gissler, Christof Klötzsch, Tomas Pfeiffer, Ralph Schneider, Leander Söhl, Michael Wennrich, Angelika Alonso, Michael Keese, Christoph Groden, Andreas Cöster, Andreas Engelhardt, Christoph-Maria Ratusinski, Bengt Berg, Martin Delle, Johan Formgren, Peter Gillgren, Lotta Jarl, Torbjörn B Kall, Peter Konrad, Niklas Nyman, Claes Skiöldebrand, Johnny Steuer, Rabbe Takolander, Jonas Malmstedt, Stefan Acosta, Katarina Björses, Kerstin Brandt, Nuno Dias, Anders Gottsäter, Jan Holst, Thorarinn Kristmundsson, Tobias Kühme, Tilo Kölbel, Bengt Lindblad, Mats Lindh, Martin Malina, Tomas Ohrlander, Tim Resch, Viola Rönnle, Björn Sonesson, Margareta Warvsten, Zbigniew Zdanowski, Erik Campbell, Per Kjellin, Hans Lindgren, Johan Nyberg, Björn Petersen, Gunnar Plate, Håkan Pärsson, Peter Qvarfordt, Pavel Ignatenko, Andrey Karpenko, Vladimir Starodubtsev, Mikhail A Chernyavsky, Maria S Golovkova, Boris B Komakha, Nikolay N Zherdev, Andrey Belyasnik, Pavel Chechulov, Dmitry Kandyba, Igor Stepanishchev, Csaba Csobay-Novák, Edit Dósa, László Entz, Balázs Nemes, Zoltán Szeberin, Pál Barzó, Mihaly Bodosi, Eniko Fákó, Béla Fülöp, Tamás Németh, Szilárd Pazdernyik, Krisztina Skoba, Erika Vörös, Eleni Chatzinikou, Athanasios Giannoukas, Christos Karathanos, Stylianos Koutsias, Georgios Kouvelos, Miltiadis Matsagkas, Styliani Ralli, Christos Rountas, Nikolaos Rousas, Konstantinos Spanos, Elias Brountzos, John D Kakisis, Andreas Lazaris, Konstantinos G Moulakakis, Leonidas Stefanis, Georgios Tsivgoulis, Spyros Vasdekis, Constantine N Antonopoulos, Ion Bellenis, Dimitrios Maras, Antonios Polydorou, Victoria Polydorou, Antonios Tavernarakis, Nikolaos Ioannou, Maria Terzoudi, Miltos Lazarides, Michalis Mantatzis, Kostas Vadikolias, Lukasz Dzieciuchowicz, Marcin Gabriel, Zbigniew Krasinski, Grzegorz Oszkinis, Fryderyk Pukacki, Maciej Slowinski, Michal-Goran Stanišic, Ryszard Staniszewski, Jolanta Tomczak, Maciej Zielinski, Piotr Myrcha, Dorota Rózanski, Stanislaw Drelichowski, Wojciech Iwanowski, Katarzyna Koncewicz, Pawel Bialek, Zbigniew Biejat, Wojciech Czepel, Anna Czlonkowska, Anatol Dowzenko, Julia Jedrzejewska, Adam Kobayashi, Jerzy Leszczynski, Andrzej Malek, Jerzy Polanski, Robert Proczka, Maciej Skorski, Mieczyslaw Szostek, Piotr Andziak, Maciej Dratwicki, Robert Gil, Miroslaw Nowicki, Jaroslaw Pniewski, Jaroslaw Rzezak, Piotr Seweryniak, Pawel Dabek, Michal Juszynski, Grzegorz Madycki, Bartosz Pacewski, Witold Raciborski, Piotr Slowinski, Walerian Staszkiewicz, Martin Bombic, Vladimír Chlouba, Jirí Fiedler, Karel Hes, Petr Koštál, Jindrich Sova, Zdenek Kríž, Mojmír Prívara, Michal Reif, Robert Staffa, Robert Vlachovský, Bohuslav Vojtíšek, Tomáš Hrbác, Martin Kuliha, Václav Procházka, Martin Roubec, David Školoudík, David Netuka, Anna Šteklácová, Vladimír Beneš III, Pavel Buchvald, Ladislav Endrych, Miroslav Šercl, Walter Campos Jr, Ivan B Casella, Nelson de Luccia, André E V Estenssoro, Calógero Presti, Pedro Puech-Leão, Celso R B Neves, Erasmo S da Silva, Cid J Sitrângulo Jr, José A T Monteiro, Gisela Tinone, Marcelo Bellini Dalio, Edwaldo E Joviliano, Octávio M Pontes Neto, Mauricio Serra Ribeiro, Patrick Cras, Jeroen M H Hendriks, Mieke Hoppenbrouwers, Patrick Lauwers, Caroline Loos, Laetitia Yperzeele, Mia Geenens, Dimitri Hemelsoet, Isabelle van Herzeele, Frank Vermassen, Parla Astarci, Frank Hammer, Valérie Lacroix, André Peeters, Robert Verhelst, Silvana Cirelli, Pol Dormal, Annelies Grimonprez, Bart Lambrecht, Philipe Lerut, Eddy Thues, Guy De Koster, Quentin Desiron, Alain Maertens de Noordhout, Danielle Malmendier, Mireille Massoz, Georges Saad, Marc Bosiers, Joren Callaert, Koen Deloose, Estrella Blanco Cañibano, Beatriz García Fresnillo, Mercedes Guerra Requena, Pilar C Morata Barrado, Miguel Muela Méndez, Antonio Yusta Izquierdo, Fernando Aparici Robles, Paula Blanes Orti, Luis García Dominguez, Rafael Martínez López, Manuel Miralles Hernández, José I Tembl Ferrairo, Ángel Chamorro, Juan Macho, Víctor Obach, Vincent Riambau, Luis San Román, Frank J Ahlhelm, Kristine Blackham, Stefan Engelter, Thomas Eugster, Henrik Gensicke, Lorenz Gürke, Philippe Lyrer, Luigi Mariani, Marina Maurer, Edin Mujagic, Mandy Müller, Marios Psychogios, Peter Stierli, Christoph Stippich, Christopher Traenka, Thomas Wolff, Benjamin Wagner, Martina M Wiegert, Sandra Clarke, Michael Diepers, Ernst Gröchenig, Philipp Gruber, Andrej Isaak, Timo Kahles, Regula Marti, Krassen Nedeltchev, Luca Remonda, Nadir Tissira, Martina Valença Falcão, Gert J de Borst, Rob H Lo, Frans L Moll, Raechel Toorop, Bart H van der Worp, Evert J Vonken, Jaap L Kappelle, Ommid Jahrome, Floris Vos, Wouter Schuiling, Hendrik van Overhagen, Rudolf W M Keunen, Bob Knippenberg, Jan J Wever, Jan W Lardenoije, Michel Reijnen, Luuk Smeets, Steven van Sterkenburg, Gustav Fraedrich, Elke Gizewski, Ingrid Gruber, Michael Knoflach, Stefan Kiechl, Barbara Rantner, Timur Abdulamit, Patrice Bergeron, Raymond Padovani, Jean-Christophe Trastour, Jean-Marie Cardon, Anne Le Gallou-Wittenberg, Eric Allaire, Jean-Pierre Becquemin, Frédéric Cochennec-Paliwoda, Pascal Desgranges, Hassan Hosseini, Hicham Kobeiter, Jean Marzelle, Mohammed A Almekhlafi, Simerpreet Bal, Phillip A Barber, Shelagh B Coutts, Andrew M Demchuk, Muneer Eesa, Michelle Gillies, Mayank Goyal, Michael D Hill, Mark E Hudon, Anitha Jambula, Carol Kenney, Gary Klein, Marie McClelland, Alim Mitha, Bijoy K Menon, William F Morrish, Steven Peters, Karla J Ryckborst, Greg Samis, Supriya Save, Eric E Smith, Peter Stys, Suresh Subramaniam, Garnette R Sutherland, Tim Watson, John H Wong, L Zimmel, Vojko Flis, Jože Matela, Kazimir Miksic, Franko Milotic, Božidar Mrdja, Barbara Stirn, Erih Tetickovic, Mladen Gasparini, Anton Grad, Ingrid Kompara, Zoren Miloševic, Veronika Palmiste, Toomas Toomsoo, Balzhan Aidashova, Nursultan Kospanov, Roman Lyssenko, Daulet Mussagaliev, Rafi Beyar, Aaron Hoffman, Tony Karram, Arthur Kerner, Eugenia Nikolsky, Samy Nitecki, Silva Andonova, Chavdar Bachvarov, Vesko Petrov, Ivan Cvjetko, Vinko Vidjak, Damir Halužan, Mladen Petrunic, Bao Liu, Chang-Wei Liu, Daniel Bartko, Peter Beno, František Rusnák, Kamil Zelenák, Masayuki Ezura, Takashi Inoue, Naoto Kimura, Ryushi Kondo, Yasushi Matsumoto, Hiroaki Shimizu, Hidenori Endo, Eisuke Furui, Søren Bakke, Kristen Krohg-Sørensen, Terje Nome, Mona Skjelland, Bjørn Tennøe, João Albuquerque e Castro, Gonçalo Alves, Frederico Bastos Gonçalves, José de Aragão Morais, Ana C Garcia, Hugo Valentim, Leonor Vasconcelos, Fernando Belcastro, Fernando Cura, Patricio Zaefferer, Foad Abd-Allah, Mohamed H Eldessoki, Hussein Heshmat Kassem, Haytham Soliman Gharieb, Mary P Colgan, Syed N Haider, Joe Harbison, Prakash Madhavan, Dermot Moore, Gregor Shanik, Viviane Kazan, Munier Nazzal, Vicki Ramsey-Williams, ACST-2 Collaborative Group, Group, ACST-2 Collaborative, Halliday A., Bulbulia R., Bonati L.H., Chester J., Cradduck-Bamford A., Peto R., Pan H., Potter J., Henning Eckstein H., Farrell B., Flather M., Mansfield A., Mihaylova B., Rahimi K., Simpson D., Thomas D., Sandercock P., Gray R., Molyneux A., Shearman C.P., Rothwell P., Belli A., Herrington W., Judge P., Leopold P., Mafham M., Gough M., Cao P., MacDonald S., Bari V., Berry C., Bradshaw S., Brudlo W., Clarke A., Cox R., Fathers S., Gaba K., Gray M., Hayter E., Holliday C., Kurien R., Lay M., le Conte S., McManus J., Madgwick Z., Morris D., Munday A., Pickworth S., Ostasz W., Poorthuis M., Richards S., Teixeira L., Tochlin S., Tully L., Wallis C., Willet M., Young A., Casana R., Malloggi C., Odero A., Silani V., Parati G., Malchiodi G., Malferrari G., Strozzi F., Tusini N., 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E., Bernardini G., DeMarco E., Giaquinta A., Patti F., Veroux M., Veroux P., Virgilio C., Mangialardi N., Orrico M., Di Lazzaro V., Montelione N., Spinelli F., Stilo F., Cernetti C., Irsara S., Maccarrone G., Tonello D., Visona A., Zalunardo B., Chisci E., Michelagnoli S., Troisi N., Masato M., Dei Negri M., Pacchioni A., Sacca S., Amatucci G., Cannizzaro A., Accrocca F., Ambrogi C., Barbazza R., Marcucci G., Siani A., Bajardi G., Savettieri G., Argentieri A., Corbetta R., Quaretti P., Thyrion F.Z., Cappelli A., Benevento D., De Donato G., Mele M.A., Palasciano G., Pieragalli D., Rossi A., Setacci C., Setacci F., Palombo D., Perfumo M.C., Martelli E., Paolucci A., Trimarchi S., Grassi V., Grimaldi L., La Rosa G., Mirabella D., Scialabba M., Sichel L., D'Angelo C.L., Fadda G.F., Kasemi H., Marino M., Burzotta F., Codispoti F.A., Ferrante A., Tinelli G., Tshomba Y., Vincenzoni C., Amis D., Anderson D., Catterson M., Clarke M., Davis M., Dixit A., Dyker A., Ford G., Jackson R., Kappadath S., Lambert D., Lees T., Louw S., McCaslin J., Parr N., Robson R., Stansby G., Wales L., Wealleans V., Wilson L., Wyatt M., Baht H., Balogun I., Burger I., Cosier T., Cowie L., Gunathilagan G., Hargroves D., Insall R., Jones S., Rudenko H., Schumacher N., Senaratne J., Thomas G., Thomson A., Webb T., Brown E., Esisi B., Mehrzad A., MacSweeney S., McConachie N., Southam A., Sunman W., Abdul-Hamiq A., Bryce J., Chetter I., Ettles D., Lakshminarayan R., Mitchelson K., Rhymes C., Robinson G., Scott P., Vickers A., Ashleigh R., Butterfield S., Gamble E., Ghosh J., McCollum C.N., Welch M., Welsh S., Wolowczyk L., Donnelly M., D'Souza S., Egun A.A., Gregary B., Joseph T., Kelly C., Punekar S., Rahi M.A., Raj S., Seriki D., Thomson G., Brown J., Durairajan R., Grunwald I., Guyler P., Harman P., Jakeways M., Khuoge C., Kundu A., Loganathan T., Menon N., Prabakaran R.O., Sinha D., Thompson V., Tysoe S., Briley D., Darby C., Hands L., Howard D., Kuker W., Schulz U., Teal R., Barer D., Brown A., Crawford S., Dunlop P., Krishnamurthy R., Majmudar N., Mitchell D., Myint M.P., O'Brien R., O'Connell J., Sattar N., Vetrivel S., Beard J., Cleveland T., Gaines P., Humphreys J., Jenkins A., King C., Kusuma D., Lindert R., Lonsdale R., Nair R., Nawaz S., Okhuoya F., Turner D., Venables G., Dorman P., Hughes A., Jones D., Mendelow D., Rodgers H., Raudoniitis A., Enevoldson P., Nahser H., O'Brien I., Torella F., Watling D., White R., Brown P., Dutta D., Emerson L., Hilltout P., Kulkarni S., Morrison J., Poskitt K., Slim F., Smith S., Tyler A., Waldron J., Whyman M., Bajoriene M., Baker L., Colston A., Eliot-Jones B., Gramizadeh G., Lewis-Clarke C., McCafferty L., Oliver D., Palmer D., Patil A., Pegler S., Ramadurai G., Roberts A., Sargent T., Siddegowda S., Singh-Ranger R., Williams A., Williams L., Windebank S., Zuromskis T., Alwis L., Angus J., Asokanathan A., Fornolles C., Hardy D., Hunte S., Justin F., Phiri D., Mitabouana-Kibou M., Sekaran L., Sethuraman S., Tate M.L., Akyea-Mensah J., Ball S., Chrisopoulou A., Keene E., Phair A., Rogers S., Smyth J.V., Bicknell C., Chataway J., Cheshire N., Clifton A., Eley C., Gibbs R., Hamady M., Hazel B., James A., Jenkins M., Khanom N., Lacey A., Mireskandari M., O'Reilly J., Pereira A., Sachs T., Wolfe J., Davey P., Rogers G., Smith G., Tervit G., Nichol I., Parry A., Young G., Ashley S., Barwell J., Dix F., Nor A.M., Parry C., Birt A., Davies P., George J., Graham A., Jonker L., Kelsall N., Potts C., Wilson T., Crinnion J., Cuenoud L., Aleksic N., Babic S., Ilijevski N., Radak, Sagic D., Tanaskovic S., Colic M., Cvetic V., Davidovic L., Jovanovic D.R., Koncar I., Mutavdzic P., Sladojevic M., Tomic I., Debus E.S., Grzyska U., Otto D., Thomalla G., Barlinn J., Gerber J., Haase K., Hartmann C., Ludwig S., Putz V., Reeps C., Schmidt C., Weiss N., Werth S., Winzer S., Gemper J., Gunther A., Heiling B., Jochmann E., Karvouniari P., Klingner C., Mayer T., Schubert J., Schulze-Hartung F., Zanow J., Bausback Y., Borger F., Botsios S., Branzan D., Braunlich S., Holzer H., Lenzer J., Piorkowski C., Richter N., Schuster J., Scheinert D., Schmidt A., Staab H., Ulrich M., Werner M., Berger H., Biro G., Eckstein H.-H., Kallmayer M., Kreiser K., Zimmermann A., Berekoven B., Frerker K., Gordon V., Torsello G., Arnold S., Dienel C., Storck M., Biermaier B., Gissler H.M., Klotzsch C., Pfeiffer T., Schneider R., Sohl L., Wennrich M., Alonso A., Keese M., Groden C., Coster A., Engelhardt A., Ratusinski C.-M., Berg B., Delle M., Formgren J., Gillgren P., Jarl L., Kall T.B., Konrad P., Nyman N., Skioldebrand C., Steuer J., Takolander R., Malmstedt J., Acosta S., Bjorses K., Brandt K., Dias N., Gottsater A., Holst J., Kristmundsson T., Kuhme T., Kolbel T., Lindblad B., Lindh M., Malina M., Ohrlander T., Resch T., Ronnle V., Sonesson B., Warvsten M., Zdanowski Z., Campbell E., Kjellin P., Lindgren H., Nyberg J., Petersen B., Plate G., Parsson H., Qvarfordt P., Ignatenko P., Karpenko A., Starodubtsev V., Chernyavsky M.A., Golovkova M.S., Komakha B.B., Zherdev N.N., Belyasnik A., Chechulov P., Kandyba D., Stepanishchev I., Csobay-Novak C., Dosa E., Entz L., Nemes B., Szeberin Z., Barzo P., Bodosi M., Fako E., Fulop B., Nemeth T., Pazdernyik S., Skoba K., Voros E., Chatzinikou E., Giannoukas A., Karathanos C., Koutsias S., Kouvelos G., Matsagkas M., Ralli S., Rountas C., Rousas N., Spanos K., Brountzos E., Kakisis J.D., Lazaris A., Moulakakis K.G., Stefanis L., Tsivgoulis G., Vasdekis S., Antonopoulos C.N., Bellenis I., Maras D., Polydorou A., Polydorou V., Tavernarakis A., Ioannou N., Terzoudi M., Lazarides M., Mantatzis M., Vadikolias K., Dzieciuchowicz L., Gabriel M., Krasinski Z., Oszkinis G., Pukacki F., Slowinski M., Stanisic M.-G., Staniszewski R., Tomczak J., Zielinski M., Myrcha P., Rozanski D., Drelichowski S., Iwanowski W., Koncewicz K., Bialek P., Biejat Z., Czepel W., Czlonkowska A., Dowzenko A., Jedrzejewska J., Kobayashi A., Leszczynski J., Malek A., Polanski J., Proczka R., Skorski M., Szostek M., Andziak P., Dratwicki M., Gil R., Nowicki M., Pniewski J., Rzezak J., Seweryniak P., Dabek P., Juszynski M., Madycki G., Pacewski B., Raciborski W., Slowinski P., Staszkiewicz W., Bombic M., Chlouba V., Fiedler J., Hes K., Kostal P., Sova J., Kriz Z., Privara M., Reif M., Staffa R., Vlachovsky R., Vojtisek B., Hrbac T., Kuliha M., Prochazka V., Roubec M., Skoloudik D., Netuka D., Steklacova A., Benes III V., Buchvald P., Endrych L., Sercl M., Campos W., Casella I.B., de Luccia N., Estenssoro A.E.V., Presti C., Puech-Leao P., Neves C.R.B., da Silva E.S., Sitrangulo C.J., Monteiro J.A.T., Tinone G., Bellini Dalio M., Joviliano E.E., Pontes Neto O.M., Serra Ribeiro M., Cras P., Hendriks J.M.H., Hoppenbrouwers M., Lauwers P., Loos C., Yperzeele L., Geenens M., Hemelsoet D., van Herzeele I., Vermassen F., Astarci P., Hammer F., Lacroix V., Peeters A., Verhelst R., Cirelli S., Dormal P., Grimonprez A., Lambrecht B., Lerut P., Thues E., De Koster G., Desiron Q., Maertens de Noordhout A., Malmendier D., Massoz M., Saad G., Bosiers M., Callaert J., Deloose K., Blanco Canibano E., Garcia Fresnillo B., Guerra Requena M., Morata Barrado P.C., Muela Mendez M., Yusta Izquierdo A., Aparici Robles F., Blanes Orti P., Garcia Dominguez L., Martinez Lopez R., Miralles Hernandez M., Tembl Ferrairo J.I., Chamorro A., Macho J., Obach V., Riambau V., San Roman L., Ahlhelm F.J., Blackham K., Engelter S., Eugster T., Gensicke H., Gurke L., Lyrer P., Mariani L., Maurer M., Mujagic E., Muller M., Psychogios M., Stierli P., Stippich C., Traenka C., Wolff T., Wagner B., Wiegert M.M., Clarke S., Diepers M., Grochenig E., Gruber P., Isaak A., Kahles T., Marti R., Nedeltchev K., Remonda L., Tissira N., Valenca Falcao M., de Borst G.J., Lo R.H., Moll F.L., Toorop R., van der Worp B.H., Vonken E.J., Kappelle J.L., Jahrome O., Vos F., Schuiling W., van Overhagen H., Keunen R.W.M., Knippenberg B., Wever J.J., Lardenoije J.W., Reijnen M., Smeets L., van Sterkenburg S., Fraedrich G., Gizewski E., Gruber I., Knoflach M., Kiechl S., Rantner B., Abdulamit T., Bergeron P., Padovani R., Trastour J.-C., Cardon J.-M., Le Gallou-Wittenberg A., Allaire E., Becquemin J.-P., Cochennec-Paliwoda F., Desgranges P., Hosseini H., Kobeiter H., Marzelle J., Almekhlafi M.A., Bal S., Barber P.A., Coutts S.B., Demchuk A.M., Eesa M., Gillies M., Goyal M., Hill M.D., Hudon M.E., Jambula A., Kenney C., Klein G., McClelland M., Mitha A., Menon B.K., Morrish W.F., Peters S., Ryckborst K.J., Samis G., Save S., Smith E.E., Stys P., Subramaniam S., Sutherland G.R., Watson T., Wong J.H., Zimmel L., Flis V., Matela J., Miksic K., Milotic F., Mrdja B., Stirn B., Tetickovic E., Gasparini M., Grad A., Kompara I., Milosevic Z., Palmiste V., Toomsoo T., Aidashova B., Kospanov N., Lyssenko R., Mussagaliev D., Beyar R., Hoffman A., Karram T., Kerner A., Nikolsky E., Nitecki S., Andonova S., Bachvarov C., Petrov V., Cvjetko I., Vidjak V., Haluzan D., Petrunic M., Liu B., Liu C.-W., Bartko D., Beno P., Rusnak F., Zelenak K., Ezura M., Inoue T., Kimura N., Kondo R., Matsumoto Y., Shimizu H., Endo H., Furui E., Bakke S., Krohg-Sorensen K., Nome T., Skjelland M., Tennoe B., Albuquerque e Castro J., Alves G., Bastos Goncalves F., de Aragao Morais J., Garcia A.C., Valentim H., Vasconcelos L., Belcastro F., Cura F., Zaefferer P., Abd-Allah F., Eldessoki M.H., Heshmat Kassem H., Soliman Gharieb H., Colgan M.P., Haider S.N., Harbison J., Madhavan P., Moore D., Shanik G., Kazan V., Nazzal M., Ramsey-Williams V., and Gargiulo M

Subjects
Male, medicine.medical_specialty, Time Factors, Time Factor, medicine.medical_treatment, Carotid Stenosi, MEDLINE, Carotid endarterectomy, Rate ratio, Risk Assessment, Asymptomatic, law.invention, Randomized controlled trial, law, Risk Factors, carotid artery stenting (CAS), carotid endarterectomy (CEA), Stent, medicine, Humans, Carotid Stenosis, Stroke, Endarterectomy, Aged, Endarterectomy, Carotid, business.industry, carotid artery, Risk Factor, Articles, General Medicine, trial, medicine.disease, Settore MED/22 - CHIRURGIA VASCOLARE, Surgery, Stenosis, Treatment Outcome, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Female, Stents, Human medicine, medicine.symptom, business, Human
Abstract

Summary Background Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Interpretation Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Funding UK Medical Research Council and Health Technology Assessment Programme.

Published
2021

41. Complete aortic thrombosis in SARS-CoV-2 infection

Author

Fabrizio Minelli, Yamume Tshomba, Simona Sica, and Giovanni Tinelli

Subjects
2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), SARS-CoV-2, business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Aortic Diseases, COVID-19, Thrombosis, covid, Settore MED/17 - MALATTIE INFETTIVE, medicine.disease, Settore MED/22 - CHIRURGIA VASCOLARE, Aortic disease, Virology, aortic thrombosis, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Humans, Medicine, AcademicSubjects/MED00200, Cardiovascular Flashlight, business, Cardiology and Cardiovascular Medicine, Aortic thrombosis
Published
2021
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42. Spontaneous Acute Aortic Thrombosis in SARS-CoV-2 Infection

Author

Giovanni Tinelli, Yamume Tshomba, Francesco Franceschi, Loris Flora, Marcello Covino, Francesca Montanari, Domenico Dionisio, and Simona Sica

Subjects
medicine.medical_specialty, AORTIC THROMBOSIS, medicine.medical_treatment, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Embolectomy, Case Report, Disease, 030204 cardiovascular system & hematology, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, In patient, business.industry, Mortality rate, COVID-19, General Medicine, medicine.disease, Thrombosis, Settore MED/22 - CHIRURGIA VASCOLARE, Surgery, Cardiology and Cardiovascular Medicine, business, Thrombotic complication, Aortic thrombosis
Abstract

Introduction: The SARS-CoV-2 infection is associated with significant morbidity and mortality rates. The impact of thrombotic complications has been increasingly recognized as an important component of this disease. Case reports: We describe four cases of spontaneous acute aortic thrombosis in patients with SARS-CoV-2 infection observed from March to December 2020 at Fondazione Policlinico Universitario Gemelli IRCCS in Rome, Italy.

Published
2021

43. Wound Care during COVID-19 Pandemic

Author

Dario Pitocco, Yamume Tshomba, Giovanni Tinelli, Giorgio Guarnera, and Simona Sica

Subjects
medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Pneumonia, Viral, Comorbidity, vascular surgery, Article, Betacoronavirus, Wound care, Pandemic, medicine, Humans, Disease management (health), Intensive care medicine, Pandemics, SARS-CoV-2, business.industry, pandemic, Disease Management, General Medicine, Settore MED/22 - CHIRURGIA VASCOLARE, Settore MED/15 - MALATTIE DEL SANGUE, covid-19, wound care during covid 19 pandemic, Wounds and Injuries, Surgery, Coronavirus Infections, business, Cardiology and Cardiovascular Medicine, wound care
Published
2020
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44. Open conversion after Nellix endovascular aneurysm sealing

Author

Francesca De Nigris, Simona Sica, Yamume Tshomba, Giovanni Tinelli, Fabrizio Minelli, and Francesco Alberto Codispoti

Subjects
medicine.medical_specialty, lcsh:Diseases of the circulatory (Cardiovascular) system, lcsh:Surgery, Endovascular aneurysm sealing (EVAS), 030204 cardiovascular system & hematology, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Aneurysm, Case report, Medicine, cardiovascular diseases, business.industry, lcsh:RD1-811, medicine.disease, Personalized medicine, Abdominal aortic aneurysm, Surgery, open conversion after nellix endovascular aneurysm sealing, Settore MED/15 - MALATTIE DEL SANGUE, lcsh:RC666-701, cardiovascular system, Open conversion, Cardiology and Cardiovascular Medicine, business, Nellix
Abstract

The Nellix endovascular aneurysm sealing system (Endologix, Irvine, Calif) was presented as a novel concept in the treatment of abdominal aortic aneurysm. After numerous adverse events, the device was voluntarily withdrawn from the market by the manufacturer. This video describes the technical approach of a successful explantation of the Nellix endograft in a patient who underwent endovascular aneurysm sealing for abdominal aortic aneurysm.

Published
2020

45. Management of Vascular Surgical Urgencies during COVID-19 Pandemic

Author

Giovanni Tinelli, F Montanari, and Yamume Tshomba

Subjects
2019-20 coronavirus outbreak, medicine.medical_specialty, Time Factors, Coronavirus disease 2019 (COVID-19), business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Rome, MEDLINE, COVID-19, General Medicine, Pandemic, Correspondence, medicine, Humans, Surgery, Vascular Diseases, Intensive care medicine, business, Cardiology and Cardiovascular Medicine, Delivery of Health Care, Vascular Surgical Procedures
Published
2020

46. Vascular Surgery Education during COVID-19 pandemic

Author

Giovanni Tinelli, Yamume Tshomba, Fabrizio Minelli, and Simona Sica

Subjects
medicine.medical_specialty, 2019-20 coronavirus outbreak, Students, Medical, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Pneumonia, Viral, MEDLINE, Article, Betacoronavirus, Surveys and Questionnaires, Pandemic, medicine, Humans, Pandemics, vascular surgery education during COVID-19 pandemic, Surgeons, education, Infection Control, business.industry, SARS-CoV-2, COVID-19, Internship and Residency, Vascular surgery, Settore MED/22 - CHIRURGIA VASCOLARE, Settore MED/15 - MALATTIE DEL SANGUE, Emergency medicine, Surgery, business, Cardiology and Cardiovascular Medicine, Coronavirus Infections, Vascular Surgical Procedures, Computer-Assisted Instruction
Published
2020

47. Laterally Extended Pelvic Resection for Gynaecological Malignancies: A Multicentric Experience with Out-of-the-Box Surgery

Author

Ali Kucukmetin, Giovanni Tinelli, Nicolò Bizzarri, Giovanni Scambia, David Cibula, Giuseppe Vizzielli, Raj Naik, and L Dostalek

Subjects
Adult, medicine.medical_specialty, Genital Neoplasms, Female, medicine.medical_treatment, Pelvic tumour, Complete resection, Resection, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Surgical oncology, medicine, Humans, Aged, Pelvic Neoplasms, Retrospective Studies, R0 resection, business.industry, Middle Aged, Pelvic Exenteration, Surgery, Survival Rate, Radiation therapy, Perioperative death, Treatment Outcome, Oncology, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, Postsurgical complications, Neoplasm Recurrence, Local, business, Follow-Up Studies
Abstract

To evaluate morbidity and oncological outcome in a multicentre series of women with gynaecological malignancies infiltrating pelvic side wall (PSW) that received laterally extended pelvic resection (LEPR). Patients operated between 2007 and 2017 at three institutions were included. LEPR was defined as an en bloc lateral resection of a pelvic tumour involving sidewall muscle, and/or bone, and/or major nerve, and/or major vascular structure. Postsurgical complications and survivals were evaluated. Sixty-three women with gynaecological tumours involving PSW were treated with LEPR. Five women underwent primary LEPR, whereas 58 (92%) patients needed LEPR because of recurrence. Twenty-four women (38%) received previous radiation therapy before the surgery. R0 resection was achieved in 54 patients (85.7%), whereas the pathologic margins were microscopically and macroscopically positive in 8 (12.7%) patients and 1 (1.6%) patient, respectively. There was one perioperative death, whereas major postoperative complications occurred in 17 patients (27.7%). Thirty (47.5%) women experienced recurrences: 24/54 (44.4%) were in the R0 group, and 6/9 (66.6%) were in the R1 group, with a median PFS of 15 months and 7 months, respectively (p = 0.024). In total, 11 of 54 (20.3%) patients died of disease in the R0 group and 5 of 9 (55.5%) in the R1 group; a median OS was not reached and was 32 months for R0 and R1 groups, respectively (p = 0.033). Involvement of the PSW should not prevent obtaining R0 resection. Although the LEPR is associated with considerable morbidity (≈ 30%), a long-term survival seems to be achieved in those women with complete resection.

Published
2018
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48. A case of sciatica revealing a giant syphilitic aneurysm

Author

Francesco Iodice, Tommaso Verdolotti, Luca Padua, Giovanni Tinelli, and Emanuele Maria Costantini

Subjects
Male, medicine.medical_specialty, Sciatic Neuropathy, Iliac artery giant aneurysm, Tertiary Syphilis, Sciatica, 03 medical and health sciences, EMG, Magnetic resonance imaging, 0302 clinical medicine, medicine, Humans, Syphilis, 030212 general & internal medicine, Aged, Syphilitic aneurysm, medicine.diagnostic_test, business.industry, Sciatic neuropathy, Tertiary syphilis, General Medicine, Settore MED/22 - CHIRURGIA VASCOLARE, Settore MED/37 - NEURORADIOLOGIA, Settore MED/26 - NEUROLOGIA, Iliac Aneurysm, 030220 oncology & carcinogenesis, Surgery, Neurology (clinical), Radiology, medicine.symptom, business
Published
2018
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49. A propensity-matched comparison of fenestrated endovascular aneurysm repair and open surgical repair of pararenal and paravisceral aortic aneurysms

Author

Gian Luca Di Tanna, Maria Antonietta Crea, Francesco Snider, Jonathan Sobocinski, Chiara de Waure, Jean-Pierre Becquemin, Stéphan Haulon, and Giovanni Tinelli

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Population, 030204 cardiovascular system & hematology, Endovascular aneurysm repair, Blood Vessel Prosthesis Implantation, 03 medical and health sciences, Aortic aneurysm, Postoperative Complications, 0302 clinical medicine, Aneurysm, Blood vessel prosthesis, fenestrated endovascular aneurysm repair, Humans, Medicine, 030212 general & internal medicine, Propensity Score, education, Survival rate, Dialysis, Aged, Retrospective Studies, education.field_of_study, Surgery, Cardiology and Cardiovascular Medicine, business.industry, Endovascular Procedures, Middle Aged, medicine.disease, paravisceral aortic aneurysms, Settore MED/22 - CHIRURGIA VASCOLARE, Blood Vessel Prosthesis, Survival Rate, Treatment Outcome, Female, pararenal aortic aneurysms, business, Aortic Aneurysm, Abdominal, Kidney disease
Abstract

Objective This study investigated the outcomes of a current series of patients treated with fenestrated and branched endovascular aneurysm repair (F-BEVAR) or open surgical repair (OSR) for pararenal abdominal aortic aneurysms (pr-AAAs), including juxtarenal, suprarenal, and type IV thoracoabdominal aneurysms. This study compares the outcomes of these procedures from two high-volume centers without the bias induced by a learning curve. Methods All patients with pr-AAAs undergoing repair at two centers between January 2010 and June 2016 were included in a prospective database. Patients undergoing F-BEVAR and OSR were propensity matched for age, sex, anatomic criteria (aortic clamp site), coronary artery disease, chronic obstructive pulmonary disease, diabetes, smoking, chronic kidney disease, aneurysm diameter, and previous aortic surgery. The primary end points were mortality and dialysis. Secondary end points included any myocardial ischemia, respiratory and early procedural complications, acute kidney injury (AKI) according to RIFLE criteria (Risk, Injury, Failure, Loss of kidney function, and End-stage renal failure), spinal cord ischemia, a composite of these complications, and postoperative intensive care unit length of stay. During follow-up, all-cause survival and freedom from reintervention were compared, as was the patency of stented vessels and renal and visceral bypasses. Late renal function deterioration was evaluated. Results In this period, 157 F-BEVAR patients and 119 OSR patients were operated on. After 1:1 propensity matching, the study cohort consisted of 102 F-BEVARs and 102 OSRs. In the matched population, an average of 2.5 vessels were treated per patient. Univariate analysis demonstrated no significant difference in 30-day mortality (2.9% vs 2.0%; P = .68), dialysis (4.9% vs 3.9%; P = 1), cardiac ischemic complications (3.8% vs 5.9%; P = .52), pulmonary complications (5.9% vs 5.9%; P = 1), or any complications (28.4% vs 30.4%; P = .63) in the F-BEVAR and OSR groups, respectively. AKI was significantly lower in the F-BEVAR group than in the OSR group (19.6% vs 52%; P 50% decrease in glomerular filtration rate, 6.9% vs 16.7%; P = .03). There was no spinal cord ischemia. The median intensive care unit length of stay was 1 day in both groups (P = .33). During follow-up, we found occlusions of five stented vessels and three surgical bypasses. Late renal function deterioration was comparable between the two groups. According to Kaplan-Meier estimates, all-cause survival at 24, 48, and 72 months was 85.6%, 66.8%, and 55.8% after F-BEVAR and 90.5%, 82.9%, and 68.5% after OSR (P = .04). Rates of freedom from reintervention were 97.6% vs 97.5% at 24 months, 90.1% vs 93.4% at 48 months, and 63.9% vs 93.4% at 72 months in the F-BEVAR and OSR groups (P = .05), respectively. Thus, both all-cause survival and freedom from reintervention were lower in the F-BEVAR group. Conclusions This propensity score analysis in patients with pr-AAA undergoing F-BEVAR or OSR suggests no difference in terms of 30-day mortality, dialysis, or organ-specific postoperative complications, with the exception of AKI. Postoperative AKI was significantly higher after OSR, although most patients had recovered before discharge. Our data suggest similar outcomes after F-BEVAR or OSR for pr-AAA.

Published
2018
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50. Correction to: Association between carotid plaque vulnerability and high mobility group box‑1 serum levels in a diabetic population

Author

Giovanni Tinelli, Maria Margherita Rando, Giuseppe Straface, Vincenzo Arena, Andrea Leonardo Cecchini, Federico Biscetti, Elisabetta Nardella, Dario Pitocco, Antonio Gasbarrini, Andrea Flex, Massimo Massetti, Flavia Angelini, and Marco Filipponi

Subjects
medicine.medical_specialty, education.field_of_study, business.industry, Endocrinology, Diabetes and Metabolism, Population, Vulnerability, medicine.disease, Diabetes mellitus, Internal medicine, RC666-701, medicine, Diseases of the circulatory (Cardiovascular) system, Cardiology and Cardiovascular Medicine, education, business, Angiology
Published
2021

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