36 results on '"Luca Farchioni"'
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2. Analysis of predisposing factors for type III endoleaks from directional branches after branched endovascular repair for thoracoabdominal aortic aneurysms
- Author
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Stefano Gennai, Gioele Simonte, Migliari Mattia, Nicola Leone, Giacomo Isernia, Gianluigi Fino, Luca Farchioni, Massimo Lenti, and Roberto Silingardi
- Subjects
Surgery ,Cardiology and Cardiovascular Medicine - Abstract
Mid-term durability of branches has already been established, and BF-branched and fenestrated endovascular repair has shown comparable results with open repair in the treatment of thoracoabdominal aortic aneurysms (TAAAs). Nevertheless, target vessel instability remains the most frequent adverse event after complex endovascular aortic repair. Type III endoleaks from directional branches have been reported with a low incidence, but risk factors for this complication have not been investigated yet.This was a dual-center observational retrospective cohort study. Data were collected prospectively for each patient treated with branched endovascular repair between April 2008 and December 2019. The primary outcome was to assess potential risk factors for branch disconnection and fracture. A logistic regression analysis was performed, including preoperative and postoperative measurements as well as intraoperative details. A Cox regression hazard analysis was performed to evaluate the influence of preoperative aneurysm diameter and target vessel angulation on the outcome during follow-up.Two hundred ninety-five target visceral vessels (TVVs) in 91 patients were considered suitable for cannulation. Technical success was 96.9% (286/295 TVVs). The median follow-up was 32.5 months (interquartile range, 14.2-50.1 months). Twelve type III endoleaks from directional branches were detected (4.2%; 5 bridging stent graft fractures and 7 disconnections). Five type III endoleaks involved the celiac trunk (one fracture and four disconnections), five the superior mesenteric artery (four fractures and one disconnection), and two the renal arteries (both disconnections). The median time to type III endoleak was 22.2 months (interquartile range, 10.9-37.6 months). Preoperative TAAA diameter (P = .028), preoperative TVV angulation (P = .037), the use of a BeGraft stent graft as bridging stent graft (P = .001), and different stent types on the same vessel (P = .048) were associated with type III endoleak at univariable analysis. Using a BeGraft stent graft (P = .010) was the only significant factor predisposing to type III endoleak at multiple logistic regression. The Cox regression analysis showed a two-fold increased risk for type III endoleak for every 10-mm increase in preoperative TAAA diameter (hazard ratio, 2.00; 95% confidence interval, 1.08-3.72; P = .028) and a 1.5 increased risk every 12° increase of preoperative TVV angulation (hazard ratio, 1.47; 95% confidence interval, 1.02-2.10; P = .037).Type III endoleaks from directional branches are a non-negligible complication after branched endovascular repair, with a relevant incidence. They tended to be clustered on specific patients, and aneurysm diameter and TVV angulation are strictly associated with the outcome. Different stent types on the same vessel should be avoided whenever possible. An intensified follow-up should be adopted for patients with large aneurysms, implanted with first-generation BeGraft, or who have been already diagnosed with type III endoleaks.
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- 2022
3. Bridging stent graft fracture after branched endovascular aortic repair in a dual-center retrospective cohort study
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Gioele Simonte, Francesco Casali, Nicola Leone, Luca Farchioni, Roberto Silingardi, Massimo Lenti, Mattia Migliari, Giacomo Isernia, Stefano Gennai, Gennai S., Simonte G., Migliari M., Isernia G., Leone N., Casali F., Farchioni L., Lenti M., and Silingardi R.
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Male ,Reoperation ,medicine.medical_specialty ,Time Factors ,Bridging (networking) ,Endoleak ,Computed Tomography Angiography ,medicine.medical_treatment ,BEVAR ,Bridging stent ,Prosthesis Design ,Blood Vessel Prosthesis Implantation ,Postoperative Complications ,Risk Factors ,Interquartile range ,medicine.artery ,medicine ,Humans ,Superior mesenteric artery ,Target vessel instability ,Aged ,Retrospective Studies ,Computed tomography angiography ,Stent fracture ,Aortic Aneurysm, Thoracic ,medicine.diagnostic_test ,business.industry ,Incidence ,Incidence (epidemiology) ,Endovascular Procedures ,Stent ,Retrospective cohort study ,Middle Aged ,Blood Vessel Prosthesis ,Prosthesis Failure ,Surgery ,Italy ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Complication ,Follow-Up Studies - Abstract
Objective Target vessel instability is a relevant complication after thoracoabdominal aortic aneurysms branched endovascular aortic repair (BEVAR). Long-term bridging stent-graft (BSG) durability has already been established, but the incidence of long-term complications as component fractures was not deeply investigated. This paper aims to assess BSG fracture incidence and risk factors after BEVAR. Methods This was a dual-center observational retrospective cohort study. Data of each patient treated with BEVAR between April 2008 and December 2019 were prospectively collected. The primary outcome was the incidence of BSG fracture during follow-up. A logistic regression analysis was performed, including preoperative and postoperative measurements as well as intraoperative details to identify potential risk factors. Results Two hundred ninety-five target visceral vessels in 91 patients were considered suitable for cannulation. Technical success was 96.9% (286/295 target visceral vessels). The median follow-up was 32.5 months (interquartile range, 14.3-50.1 months). Five BSG fractures (1.75%; 5/286) were detected. Four BSG fractures involved the superior mesenteric artery, and one the celiac trunk. Four different types of fractured stents were detected during follow-up: two Advanta, one BeGraft, one Fluency, and one Viabahn. The median time to BSG fracture was 28.2 months (interquartile range, 11.7-50.8 months). The use of multiple stents (P = .030) and different stent types on the same vessel (P = .004) were associated with BSG fracture at univariable analysis. Using bare-metal stents for distal relining (P = .045) was the only significant factor predisposing to BSG fracture at multiple logistic regression. Conclusions BSG fracture is a rare but severe complication after BEVAR. It is not related to the stent type used as bridging stent, and it is hardly predictable based on preoperative anatomy. Using multiple and different stents on the same vessel and relining the bridging stents with bare-metal stents may increase BSG fracture risk. A strict computed tomography angiography follow-up remains the best strategy to detect target vessel instability.
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- 2022
4. Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy
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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., Vecchiati E., Coppi G., Lauricella A., Moratto R., Silingardi R., Veronesi J., Zini A., Ferrero E., Ferri M., Gaggiano A., Labate C., Nessi F., Psacharopulo D., Viazzo A., Malacrida G., Mazzaccaro D., Meola G., Modafferi A., Nano G., Occhiuto M.T., Righini P., Stegher S., Chiarandini S., Griselli F., Lepidi S., Pozzi Mucelli F., Naccarato M., D'Oria M., Ziani B., Stella A., Dieng M., Faggioli G., Gargiulo M., Palermo S., Pini R., Puddu G.M., Vacirca A., Angiletta D., Desantis C., Marinazzo D., Mastrangelo G., Regina G., Pulli R., Bianchi P., Cireni L., Coppi E., Pizzirusso R., Scalise F., Sorropago G., Tolva V., Caso V., Cieri E., DeRango P., Farchioni L., Isernia G., Lenti M., Parlani G.B., Pupo G., Pula G., Simonte G., Verzini F., Carimati F., Delodovici M.L., Fontana F., Piffaretti G., Tozzi M., Civilini E., Poletto G., Reimers B., Praquin B., Ronchey S., Capoccia L., Mansour W., Sbarigia E., Speziale F., Sirignano P., Toni D., Galeotti R., Gasbarro V., Mascoli F., Rocca T., Tsolaki 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
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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.
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- 2021
5. A prognostic risk score for major amputation in dialysis patients with chronic limb-threatening ischemia after endovascular revascularization
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Luca Farchioni, Antonio Lauricella, Nicola Leone, Enrico Giuliani, Stefano Gennai, Roberto Silingardi, Antonietta Cuccì, Farchioni L., Gennai S., Giuliani E., Cucci A., Lauricella A., Leone N., and Silingardi R.
- Subjects
Male ,medicine.medical_specialty ,Prognosi ,medicine.medical_treatment ,Ischemia ,Amputation ,Angioplasty ,Kidney failure, chronic ,Peripheral arterial disease ,Renal dialysis ,Kidney failure ,030204 cardiovascular system & hematology ,030230 surgery ,Revascularization ,Amputation, Surgical ,03 medical and health sciences ,0302 clinical medicine ,Renal Dialysis ,Risk Factors ,Retrospective Studie ,medicine ,Clinical endpoint ,Humans ,Retrospective Studies ,Aged ,Endovascular Procedure ,Framingham Risk Score ,business.industry ,Risk Factor ,Endovascular Procedures ,medicine.disease ,Prognosis ,Limb Salvage ,Surgery ,chronic ,Treatment Outcome ,Renal dialysi ,Female ,Cardiology and Cardiovascular Medicine ,business ,Major amputation ,Kidney disease ,Human - Abstract
Background Almost 38% of all patients with end-stage chronic kidney disease (CKD) have peripheral arterial disease of the lower limbs that can lead to chronic limb threatening ischemia (CLTI). The aim of this study was to assess the impact of several factors to conduct a stratification of the amputation risk in CKD patients with CLTI receiving endovascular revascularization. Methods Observational, retrospective, single-center study of patients treated from 2010 to 2016. The primary endpoint was the major amputation. The study included adult CKD dialysis patients affected by CLTI (rest pain and/or trophic lesions) with indication to endovascular revascularization and excluded for open repair. Results A total of 82 patients were considered (58 men [70.7%], 24 women [29.3%] mean age 70.4 ±15.0 years). The number of major amputations was 28 (34.1%). The arterial lesion severity (TASC II-classification) and the trophic lesions extension (WIfI classification) were significantly associated with major amputation (OR and 95%CI, 1.20 [1.07-1.34], p= .001; 2.65 [1.49-4.72], p= 0.001; respectively). Based on the abovementioned characteristics, a prognostic score was proposed to predict the major amputation risk. A score ≥23 was associated with a 67.6% probability of amputation in the following 12 months. Conclusions The CLTI revascularization is associated with poor outcomes in CKD patients. The present clinical score provided a pragmatic tool to calculate the major amputation risk. An elevated score could facilitate the decision-making process in order to perform an endovascular treatment vs conservative approach.
- Published
- 2021
6. Intravascular Ultrasound in Branched and Fenestrated Endovascular Aneurysm Repair: Initial Experience in a Single-Center Cohort Study
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Luca Farchioni, Mattia Migliari, Giuseppe Saitta, Nicola Leone, Antonio Lauricella, Roberto Silingardi, Stefano Gennai, Gennai S., Leone N., Saitta G., Migliari M., Lauricella A., Farchioni L., and Silingardi R.
- Subjects
medicine.medical_specialty ,thoracoabdominal aneurysm ,medicine.medical_treatment ,aneurysm ,endovascular aneurysm repair ,endovascular treatment/therapy ,intravascular ultrasound ,thoracoabdominal aortic aneurysm ,Single Center ,Prosthesis Design ,Endovascular aneurysm repair ,Cohort Studies ,Blood Vessel Prosthesis Implantation ,Aneurysm ,Retrospective Studie ,Intravascular ultrasound ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Thoracoabdominal aneurysm ,Ultrasonography, Interventional ,Retrospective Studies ,Aged ,medicine.diagnostic_test ,Aortic Aneurysm, Thoracic ,business.industry ,Endovascular Procedures ,medicine.disease ,equipment and supplies ,Blood Vessel Prosthesis ,Blood Vessel Prosthesi ,surgical procedures, operative ,Treatment Outcome ,cardiovascular system ,Surgery ,Female ,Radiology ,Cohort Studie ,Cardiology and Cardiovascular Medicine ,business ,Cohort study ,Human ,Aortic Aneurysm, Abdominal - Abstract
Purpose: To evaluate intravascular ultrasound (IVUS) safety and efficacy to detect visceral stenting issues during complex endovascular aneurysm repair through branched and fenestrated repair (B-FEVAR). Materials and Methods: A single-center retrospective analysis of 33 bridging stents assessed intraoperatively using IVUS between January and September 2020 was performed. Ten aortic aneurysm patients [7 thoracoabdominal / 1 pararenal / 2 juxtarenal; 3 females; mean age 73 years [range 70–77 years]) were included. Eight BEVAR (5 standard; 2 custom-made) and 2 FEVAR (custom-made) were performed. The study assessed the safety and efficacy of IVUS utilization to detect immediate branch instability after visceral stenting in the case of B-FEVAR. The primary safety endpoint was defined as the absence of IVUS-related adverse events. The primary efficacy endpoint was defined as the composite of technical success of the IVUS-assessment in each target visceral vessels (TVVs), the rate of IVUS-findings divided as prompting additional maneuvers or not, and the incidence of postoperative computed tomography angiography findings compared with intraoperative assessment. Results: There were no IVUS-related adverse events. The technical success of the IVUS-assessment was achieved in all TVVs. No technical issues compromised the evaluation of the intended vessel. Among the 7 findings identified by IVUS, 3 were suspected at the angiography. In all, 57% (4/7) had normal final angiography. IVUS was able to detect a 12% (4/33) intraoperative branch instability not identified/suspected at the completion angiography. The IVUS assessment led to an immediate revision in 5 (15%) vessels. A total of 57% (4/7) of the issues were detected in patients undergoing primary BEVAR. The remaining 43% (3/7) was detected in patients undergoing secondary intervention for branch instability. Conclusion: IVUS was safe as an adjunctive imaging technique to assess completion after B-FEVAR. It demonstrated efficacy in the detection of intraoperative issues missed by angiography. Further investigations are required to validate these promising results.
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- 2021
7. Urgent Branched Endograft Aortic Repair for Suprarenal Stent-Induced Injury
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Massimo Lenti, Beatrice Fiorucci, Giacomo Isernia, Luca Farchioni, and Gioele Simonte
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medicine.medical_specialty ,Aortography ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Radiology, Nuclear Medicine and Imaging ,Cardiology and Cardiovascular Medicine ,Stent ,030204 cardiovascular system & hematology ,medicine.disease ,Aortic repair ,03 medical and health sciences ,Aortic aneurysm ,0302 clinical medicine ,Blood vessel prosthesis ,Cardiothoracic surgery ,Nuclear Medicine and Imaging ,medicine ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Radiology ,business ,Computed tomography angiography ,Positron Emission Tomography-Computed Tomography - Published
- 2017
8. Effect of statins on survival in patients undergoing dialysis access for end-stage renal disease
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Basso Parente, Alessandra Manzone, Massimo Lenti, Paola De Rango, Gioele Simonte, Beatrice Fiorucci, Luca Farchioni, Selena Pelliccia, and Enrico Cieri
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Aged ,Aged, 80 and over ,Chi-Square Distribution ,Female ,Graft Occlusion, Vascular ,Humans ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Kaplan-Meier Estimate ,Kidney Failure, Chronic ,Male ,Middle Aged ,Odds Ratio ,Proportional Hazards Models ,Protective Factors ,Retrospective Studies ,Risk Assessment ,Risk Factors ,Time Factors ,Treatment Outcome ,Vascular Patency ,Renal Dialysis ,Surgery ,Cardiology and Cardiovascular Medicine ,030204 cardiovascular system & hematology ,Graft Occlusion ,Kidney Failure ,0302 clinical medicine ,Hyperlipidemia ,80 and over ,Clinical endpoint ,030212 general & internal medicine ,Chronic ,medicine.medical_specialty ,Statin ,medicine.drug_class ,End stage renal disease ,03 medical and health sciences ,Vascular ,Internal medicine ,Diabetes mellitus ,medicine ,cardiovascular diseases ,Proportional hazards model ,business.industry ,nutritional and metabolic diseases ,Odds ratio ,medicine.disease ,business ,Kidney disease - Abstract
The benefit of statin therapy in patients with advanced chronic kidney disease remains uncertain. Randomized trials have questioned the efficacy of the drug in improving outcomes for on-dialysis populations, and many patients with end-stage renal disease are not currently taking statins. This study aimed to investigate the impact of statin use on survival of patients with vascular access performed at a vascular center for chronic dialysis. Consecutive end-stage renal disease patients admitted for vascular access surgery in 2006 to 2013 were reviewed. Information on therapy was retrieved and patients on statins were compared to those who were not on statins. Primary endpoint was 5-year survival. Independent predictors of mortality were assessed with Cox regression analysis adjusting for covariates (ie, age, sex, hyperlipidemia, hypertension, cardiac disease, cerebrovascular disease, chronic obstructive pulmonary disease, obesity, diabetes, and statins). Three hundred fifty-nine patients (230 males; mean age 68.9 ± 13.7 years) receiving 554 vascular accesses were analyzed: 127 (35.4%) were on statins. Use of statins was more frequent in patients with hypertension (89.8% v 81%; P = .034), hyperlipidemia (52.4% v 6.2%; P < .0001), coronary disease (54.1% v 42.6%; P = .043), diabetes (39.4% v 21.6%; P = .001), and obesity (11.6% v 2.0%; P < .0001). Mean follow-up was 35 months. Kaplan-Meier survival rates at 3 and 5 years were 84.4% and 75.9% for patients taking statins and 77.0% and 65.1% for those not taking statins (P = .18). Cox regression analysis selected statins therapy as the only independent negative predictor (odds ratio = 0.55; 95% confidence interval = 0.32-0.95; P = .032) of mortality, while age was an independent positive predictor (odds ratio = 1.05; 95% confidence interval = 1.03-1.08; P < .0001). Vascular access patency was comparable in statin takers and those not taking statins (P = .60). Use of statins might halve the risk of all-cause mortality at 5 years in adult patients with vascular access for chronic dialysis. Statins therapy should be considered in end-stage renal disease populations requiring dialysis access placement.
- Published
- 2016
9. Impact of age and urgency on survival after thoracic endovascular aortic repair
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Enrico Cieri, Massimo Lenti, Gioele Simonte, Alessandro Marucchini, Fabio Verzini, Giacomo Isernia, Luca Farchioni, and Paola De Rango
- Subjects
Male ,Time Factors ,Databases, Factual ,Aorta, Thoracic ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,0302 clinical medicine ,Risk Factors ,Odds Ratio ,Risk of mortality ,Medicine ,030212 general & internal medicine ,Young adult ,Aged, 80 and over ,education.field_of_study ,Mortality rate ,Endovascular Procedures ,Age Factors ,Middle Aged ,Cardiology and Cardiovascular Medicine ,Surgery ,Treatment Outcome ,Elective Surgical Procedures ,Female ,Adult ,medicine.medical_specialty ,Adolescent ,Aortic Rupture ,Population ,Aortic Diseases ,Risk Assessment ,Young Adult ,03 medical and health sciences ,Internal medicine ,Humans ,Aortic rupture ,education ,Aged ,Chi-Square Distribution ,business.industry ,Patient Selection ,Odds ratio ,Perioperative ,Confidence interval ,Logistic Models ,Multivariate Analysis ,Emergencies ,business - Abstract
Objective Elderly patients are often turned down from receiving treatment for descending thoracic aortic diseases (DTADs) because of the uncertain benefits, especially in acute settings. This study investigated the impact of old age and timing of thoracic endovascular aortic repair (TEVAR) on outcomes of DTAD in patients older than 75 years of age. Methods Patients from a prospective TEVAR database were dichotomized by age (75 and 80 years of age). Older and young patients were compared in three timing scenarios: (1) elective procedures, (2) any emergency (within 15 days from onset), and (3) acute ruptures (any emergency subgroup). Primary outcome was perioperative mortality assessed at 30 and 90 days. Results Between 2003 and 2015, 141 consecutive TEVARs (71.6% men) were performed. Fifty-seven patients (40.4%) were older than 75 years of age; 28 were octogenarians. Eighty-three TEVARs were performed electively and 58 emergently. Among overall emergencies, 42 TEVARs were for acute ruptures. In the elective scenario, the 30-day mortality rate was 5.0% vs 0 (odds ratio [OR], 1.1; 95% confidence interval [CI], 0.98-1.1; P = .23), and 90-day mortality was 7.5% vs 0, for patients older than 75 years of age vs those who were younger than 75, respectively ( P = .11). No octogenarian died. In the emergency scenario, 30-day mortality was 41.2% vs 9.8%, for patients older than 75 years of age vs those who were younger than 75, respectively (OR, 6.5; 95% CI, 1.6-26.6; P = .01) with unchanged rates at 90 days. The mortality rate was 50% for octogenarians. In the acute rupture scenario, 30-day mortality was 40% vs 11.1% (OR, 5.3; 95% CI, 1.10-25.99; P = .05) for patients older than 75 years of age vs those younger than 75 years of age and 46% vs 10% (OR, 7.5; 95% CI, 1.47-37.46; P = .016) for octogenarians vs younger patients. Rates remained unchanged at 90 days. Patients older than age 75 survived for a mean of 53.98 ± 7.7 months after TEVAR. Conclusions In the elderly patient population with DTAD, mortality risks from TEVAR are strongly related to timing and age. When compared to younger patients, those older than 75 years of age have three to five times the risk of mortality after urgent or emergent TEVAR. However, older patients should still be considered for emergent life-saving treatment, given that the majority survives.
- Published
- 2016
10. Long Term Results with the Ovation Endograft for Abdominal Aortic Aneurysm Correction in a High Volume Center, Lights and Shadows
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Elisa Paciaroni, Giacomo Isernia, Massimo Lenti, Gugliemo Pupo, Luca Farchioni, Gioele Simonte, Enrico Cieri, and Beatrice Fiorucci
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Surgery ,Center (algebra and category theory) ,Radiology ,Long term results ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,Abdominal aortic aneurysm ,Volume (compression) - Published
- 2019
11. Rheolytic Thrombectomy with AngioJet
- Author
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Beatrice, Fiorucci, Giacomo, Isernia, Gioele, Simonte, Luca, Farchioni, Basso, Parente, Gianbattista, Parlani, and Massimo, Lenti
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Male ,Time Factors ,Aortic Aneurysm, Thoracic ,Computed Tomography Angiography ,Endovascular Procedures ,Equipment Design ,Recovery of Function ,Middle Aged ,Renal Artery Obstruction ,Aortography ,Blood Vessel Prosthesis ,Blood Vessel Prosthesis Implantation ,Treatment Outcome ,Humans ,Stents ,Vascular Access Devices ,Vascular Patency ,Aged ,Thrombectomy - Abstract
Acute occlusion of the visceral arteries is a threatening complication following branched endovascular aortic repair (EVAR). Its prompt diagnosis and treatment are mandatory to restore renal function. Several techniques have been used to manage this complication. We report 2 clinical cases of patients, previously treated with implantation of an off-the-shelf thoracoabdominal aortic endograft, with acute bilateral occlusion of the renal arteries. Both patients were successfully treated with AngioJet rheolytic thrombectomy. Acute occlusion of the renal arteries can dramatically complicate the outcome of patients treated with branched EVAR. Prompt diagnosis and treatment are required. Rheolytic thrombectomy rapidly removes intra-arterial thrombus through Bernoulli effect, preventing the risk of distal embolization and rapidly restoring the renal function.
- Published
- 2017
12. Rheolytic Thrombectomy with AngioJet®Is Safe and Effective in Revascularization of Renal Arteries' Acute Occlusion on Previous Complex Aortic Endovascular Repair
- Author
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Basso Parente, Massimo Lenti, Beatrice Fiorucci, Gioele Simonte, Luca Farchioni, Giacomo Isernia, and Gianbattista Parlani
- Subjects
medicine.medical_specialty ,Surgery ,Cardiology and Cardiovascular Medicine ,business.industry ,medicine.medical_treatment ,Distal embolization ,Renal function ,Acute occlusion ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Revascularization ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Occlusion ,medicine ,Cardiology ,Thrombus ,Complication ,business ,Previously treated - Abstract
Acute occlusion of the visceral arteries is a threatening complication following branched endovascular aortic repair (EVAR). Its prompt diagnosis and treatment are mandatory to restore renal function. Several techniques have been used to manage this complication. We report 2 clinical cases of patients, previously treated with implantation of an off-the-shelf thoracoabdominal aortic endograft, with acute bilateral occlusion of the renal arteries. Both patients were successfully treated with AngioJet rheolytic thrombectomy. Acute occlusion of the renal arteries can dramatically complicate the outcome of patients treated with branched EVAR. Prompt diagnosis and treatment are required. Rheolytic thrombectomy rapidly removes intra-arterial thrombus through Bernoulli effect, preventing the risk of distal embolization and rapidly restoring the renal function.
- Published
- 2017
13. Lesson Learned with the Use of Iliac Branch Devices: Single Centre 10 Year Experience in 157 Consecutive Procedures
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Giacomo Isernia, G. Parlani, Massimo Lenti, Fabio Verzini, Luca Farchioni, Enrico Cieri, Gioele Simonte, and Piergiorgio Cao
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Male ,Time Factors ,Multivariate analysis ,Databases, Factual ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,Postoperative Complications ,0302 clinical medicine ,EVAR ,Iliac Aneurysm ,Branched endograft ,Hypogastric ,Iliac aneurysm ,Iliac endograft ,Long term ,Aged, 80 and over ,Endovascular Procedures ,Common iliac artery ,Abdominal aortic aneurysm ,Treatment Outcome ,medicine.anatomical_structure ,Italy ,Surgery ,Cardiology and Cardiovascular Medicine ,Female ,Radiology ,Artery ,medicine.medical_specialty ,Prosthesis Design ,Disease-Free Survival ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Aneurysm ,medicine.artery ,medicine ,Humans ,Artery occlusion ,Contraindication ,Aged ,Retrospective Studies ,Chi-Square Distribution ,business.industry ,medicine.disease ,Blood Vessel Prosthesis ,Logistic Models ,Multivariate Analysis ,business ,Aortic Aneurysm, Abdominal - Abstract
Objective/Background Absence of an adequate iliac seal rarely represents an absolute contraindication to endovascular abdominal aortic aneurysm repair. Iliac branch devices (IBD) are increasingly used in patients with extensive aorto-iliac aneurysmal disease, but few data are available on the long-term results of these procedures. Methods Between 2006 and 2016, 157 consecutive IBD procedures performed at a single centre were entered into a prospective database. Indications included unilateral or bilateral common iliac artery aneurysms combined or not with abdominal aortic aneurysms. Long-term results were reported according to the Kaplan–Meier method. Results During the study period 149 patients were treated with an iliac branched endograft. Isolated IBD was implanted in 17.8% of the cases; technical success rate was 97.5%. Peri-operative procedure failure occurred in seven patients, four during surgery and three within 30 days of the procedure. Presence of ipsilateral hypogastric aneurysm ( p = .031; Exp [B] = 6.72) and intervention performed during the initial study period ( p = .006; Exp [B] = 10.40) were predictive of early failure on multivariate analysis. After a mean follow-up of 44.2 months actuarial freedom from IBD related re-intervention was 97.4%, 95.6%, 94.0%, and 91.8% at 1, 3, 5, and 9 years, respectively. Hypogastric artery patency was 94.7%, 92.6%, and 90.4% at 1, 3, and 10 years, respectively. Presence of a hypogastric aneurysm was an independent predictor of target artery occlusion during follow-up on multivariate analysis ( p = .007; Exp [B] = 5.93). Conclusion Iliac branched endografting can now be performed with a high technical success rate; long-term freedom from re-intervention is comparable with patients treated with standard aortic endografting. IBD should be considered a first-option treatment in patients with adequate vascular anatomy unsuitable for standard endovascular aortic repair.
- Published
- 2017
14. Diabetes and Abdominal Aortic Aneurysms
- Author
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P. De Rango, Luca Farchioni, Massimo Lenti, and Beatrice Fiorucci
- Subjects
Inverse Association ,medicine.medical_specialty ,Aortic Rupture ,Risk Assessment ,Aortic aneurysm prevalence ,Aortic aneurysm development ,Internal medicine ,Diabetes mellitus ,Diabetes Mellitus ,Odds Ratio ,Prevalence ,medicine ,Humans ,Mass Screening ,Hospital Mortality ,Prospective cohort study ,Medicine(all) ,business.industry ,Incidence (epidemiology) ,Aneurysm growth ,Diabetes ,Odds ratio ,medicine.disease ,Confidence interval ,Abdominal aortic aneurysm ,Checklist ,Surgery ,Aortic aneurysm incidence ,Cardiology and Cardiovascular Medicine ,business ,Diabetic Angiopathies ,Aortic Aneurysm, Abdominal - Abstract
Epidemiologic evidence suggests that patients with diabetes may have a lower incidence of abdominal aortic aneurysm (AAA); however, the link between diabetes and AAA development and expansion is unclear. The aim of this review is to analyze updated evidence to better understand the impact of diabetes on prevalence, incidence, clinical outcome, and expansion rate of AAA. A systematic review of literature published in the last 20 years using the PubMed and Cochrane databases was undertaken. Studies reporting appropriate data were identified and a meta-analysis performed using the generic inverse variance method. Sixty-four studies were identified. Methodological quality was “fair” in 16 and “good” in 44 studies according to a formal assessment checklist (Newcastle–Ottawa). In 17 large population prevalence studies there was a significant inverse association between diabetes and AAA: pooled odds ratio (OR) 0.80; 95% confidence intervals (CI) 0.70–0.90 (p = .0009). An inverse association was also confirmed by pooled analysis of data from smaller prevalence studies on selected populations (OR 0.59; 95% CI 0.35–0.99; p = .05), while no significant results were provided by case-control studies. A significant lower pooled incidence of new AAA in diabetics was found over six prospective studies: OR 0.54; 95% CI 0.31–0.91; p = .03. Diabetic patients showed increased operative (30-day/in-hospital) mortality after AAA repair: pooled OR 1.26; 95% CI 1.10–1.44; p = .0008. The increased operative risk was more evident in studies with 30-day assessment. In the long-term, diabetics showed lower survival rates at 2–5 years, while there was general evidence of lower growth rates of small AAA in patients with diabetes compared to non-diabetics. There is currently evidence to support an inverse relationship between diabetes and AAA development and enlargement, even though fair methodological quality or unclear risk of bias in many available studies decreases the strength of the finding. At the same time, operative and long-term survival is lower in diabetic patients, suggesting increased cardiovascular burden. The higher mortality in diabetics raises the question as to whether AAA repair should be individualized in selected diabetic populations at higher AAA rupture risk.
- Published
- 2014
15. Safety of Chronic Anticoagulation Therapy After Endovascular Abdominal Aneurysm Repair (EVAR)
- Author
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Fabio Verzini, Giacomo Isernia, Piergiorgio Cao, Enrico Cieri, Luca Farchioni, G. Parlani, Gioele Simonte, and P. De Rango
- Subjects
Male ,Endovascular abdominal aortic aneurysm repair ,medicine.medical_specialty ,Endoleak ,Reintervention ,Kaplan-Meier Estimate ,Disease ,Chronic anticoagulant ,Anticoagulation ,Aortic aneurysm ,Postoperative Complications ,Aneurysm ,medicine ,Humans ,EVAR ,Postoperative Period ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Aged, 80 and over ,Medicine(all) ,business.industry ,Proportional hazards model ,Endovascular Procedures ,Warfarin ,Anticoagulants ,Conversion ,Retrospective cohort study ,anticoagulation, EVAR ,medicine.disease ,Surgery ,Female ,Abdominal aneurysm ,anticoagulation ,Cardiology and Cardiovascular Medicine ,business ,Aortic Aneurysm, Abdominal ,Abdominal surgery ,medicine.drug - Abstract
ObjectiveCurrent data supporting the effect of anticoagulation drug use on aneurysm sealing and the durability of endovascular abdominal aneurysm repair (EVAR) are conflicting. This study assessed the safety of chronic anticoagulation therapy after EVAR.MethodsRecords of 1409 consecutive patients having elective EVAR during 1997–2011 who were prospectively followed were reviewed. Survival, reintervention, conversion, and endoleak rates were analyzed in patients with and without chronic anticoagulants. Cox proportional hazards models were used to estimate the effect of anticoagulation therapy on outcomes.ResultsOne-hundred and three (7.3%) patients were on chronic anticoagulation drugs (80 on vitamin K antagonists) at the time of EVAR. An additional 46 patients started on anticoagulants after repair were identified. Patients on chronic anticoagulation therapy at repair (mean age 73.6 years; 91 males) had more frequent cardiac disease (74.8% vs. 44.2%; p
- Published
- 2014
16. Mortality Risk for Ruptured Abdominal Aortic Aneurysm in Women
- Author
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Fabio Verzini, Gioele Simonte, Massimo Lenti, Giacomo Isernia, Gianbattista Parlani, Luca Farchioni, Alessandra Manzone, Enrico Cieri, and Paola De Rango
- Subjects
Male ,Time Factors ,Databases, Factual ,SURGERY ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,030230 surgery ,Aortic aneurysm ,0302 clinical medicine ,RUPTURE ,Risk Factors ,Odds Ratio ,DISSECTION ,Aged, 80 and over ,OUTCOMES ,Mortality rate ,Endovascular Procedures ,General Medicine ,Treatment Outcome ,Female ,Cardiology and Cardiovascular Medicine ,NATURAL-HISTORY ,ANEURYSMS ,MANAGEMENT ,MORTALITY ,SIZE ,SURVEILLANCE ,medicine.medical_specialty ,Aortic Rupture ,03 medical and health sciences ,Blood Vessel Prosthesis Implantation ,Aneurysm ,Sex Factors ,medicine ,Humans ,Healthcare Disparities ,Aortic rupture ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Chi-Square Distribution ,business.industry ,Retrospective cohort study ,Odds ratio ,Perioperative ,Health Status Disparities ,medicine.disease ,Surgery ,Logistic Models ,Multivariate Analysis ,business ,Abdominal surgery ,Aortic Aneurysm, Abdominal - Abstract
Sex differences in presentation and outcomes of abdominal aortic aneurysms (AAA) with increased mortality rates in women are suggested. This study aimed to assess mortality risk after repair of ruptured AAA (rAAA) in women in the endovascular abdominal aortic repair (EVAR) era.Patients treated between 2006 and 2015 for rAAA were included in a prospective database. Characteristics at presentation and outcomes were compared between women and men. Multivariable logistic regression and Cox proportional analyses were performed to identify the effect of sex adjusted for other predictors on mortality.One hundred thirteen patients were identified; of these, 17.7% (20/113) of the patients were women. Forty-four procedures (38.9%) were by EVAR, with comparable rates in women (45%) and men (37.6%, P = 0.62). On admission, women and men shared similar comorbidities and presentation (shock 45% vs. 43.0%, P = 0.81; free rupture 65.0% vs. 67.7%, P = 0.80) and comparable mean aneurysm diameter (76.5 vs. 78.8 mm, P = 0.68), but women were older (mean age 86.4 + 5.5 vs. 75.2 ± 10.6 years, P 0.0001) and octogenarian women were twice as likely as men (90% vs. 40%, P 0.0001). Perioperative mortality was comparable between women and men (40.0% vs. 38.7%) either after EVAR (22.2% vs. 40.0% in women and men respectively; odds ratio [OR] 0.45, 95% confidence interval [CI] 0.77-2.37) or after open surgery (54.5% vs. 37.9%; OR 2.0, 95% CI 0.54-7.21), even though there was a trend for lower mortality in women with EVAR. In adjusted analyses, female sex was not associated with perioperative mortality as it was for older age (octogenarians: OR 6.6, 95% CI 2.08-20.82, P = 0.001) and free rupture (OR 4.2, 95% CI 1.29-13.73, P = 0.02). Mean follow-up was 34.32 months. After controlling for age, surgical repair, free rupture, cardiac disease, and shock at presentation, female sex was not a predictor of late mortality.AAA repair is often delayed in women and applied at older age; nevertheless, currently women do not show increased perioperative mortality risks from rAAA treatment after the introduction of EVAR.
- Published
- 2016
17. Abstract TP354: Trends in Stroke Severity and Incidence After Endovascular Repair for Descending Thoracic Aorta Diseases
- Author
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Paola De Rango, Giacomo Isernia, Gioele Simonte, Alessandro Marucchini, Enrico Cieri, Luca Farchioni, and Fabio Verzini
- Subjects
Advanced and Specialized Nursing ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Abstract
Background: Perioperative stroke is a devastating complication after treatment of descending thoracic aorta disease (DTAD). As to whether developments in Thoracic Endovascular repair (TEVAR) influenced the overall stroke burden of patients with DTAD remains to be defined. This study investigated the current incidence and severity of procedure-related stroke in patients undergoing elective or emergency TEVAR. Methods: Patients with DTAD treated by TEVAR were questioned for perioperative stroke. Multivariable logistic regression models with backward variable selection were applied to investigate independent associations with perioperative stroke. Results: Between 2003-2015, 141 consecutive TEVAR (71.6% men;mean age 67.3+16.7years) were performed for DTAD: 58 (41.4%) were emergency procedures. The 30-day mortality was 9.2% (13/141) and 10 patients experienced procedure-related stroke. 30-day mortality was increased in patients with stroke: 23% vs. 5.5% (OR 5.2; 95%CI1.16-23.2;P=0.05). Stroke fatality was even more evident in elective repairs (P=0.049). Procedure-related stroke incidence was higher in emergency (13.3% vs. 2.6%;P=0-02), in procedures with left subclavian artery (LSA) coverage (21.4% vs. 3.5%;P=0.004) and in TEVAR performed before 2007 (15.6% vs 3.1%;P= 0.01). The relationship between increased stroke incidence and LSA coverage (35.7% vs. 6.5%;P=0.01) or procedure before 2007 (26.6% vs.5.1%;P=0.02) was particularly evident in TEVAR performed in emergency, while disappeared in elective repairs. Type of disease and age did not affect stroke risk. In multivariable regression, emergency of repair (OR,10.9; 95%CI,1.56-76.5; P=0.0.2), LSA coverage (OR,10.8; 95%CI 1.8-65.6;P=0.009) and procedure after 2007(OR 0.15; 95%CI 0.03-0.88;P=0.04) were confirmed as independently associated with procedure-related stroke as well as female sex (P=0.034). Conclusions: With developed technology the incidence of procedure-related stroke after TEVAR has declined. This trend was particularly achieved in emergency procedures where the prompt treatment may not allow for accurate planning. Nevertheless, stroke remains a devastating complication at high fatality risk for patients with DTAD even after elective TEVAR.
- Published
- 2016
18. Abstract TMP6: Safety From Acute Carotid Revascularization in Octogenarians With Recently Symptomatic Carotid Stenosis
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Paola De Rango, Luca Farchioni, Alessandra Manzone, Gioele Simonte, Selena Pelliccia, Enrico Cieri, Valeria Caso, and Massimo Lenti
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Advanced and Specialized Nursing ,cardiovascular diseases ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Abstract
Background: Old age is a main factor increasing perioperative risks especially in emergency. Guidelines recommend performing carotid endarterectomy (CEA) in the acute period after onset of a transient ischemic attack (TIA) or stroke. There are concerns on the benefit from acute carotid revascularization in old patients due to increased periprocedural stroke/death risks exposure during an emergency procedure that could offset the long-term benefit. This study aimed to analyze 30-day and late risk of stroke/death after acute carotid revascularization in symptomatic patients with >80years. Methods: Data of 282 consecutive patients (28.4% females; mean age 73.9y) undergoing carotid revascularization within 15 days from stroke/TIA ,in 2009-2015, were analyzed. Octogenarians and younger patients were compared for presentation, 30-day and late stroke/death rates using multivariable and survival analyses. Results: There were 79 (28%) patients with >80 years (34.2% females): 33(42%) were treated within the first 7 days and 10 (13%) within 48hours from symptom onset. Stroke was the index event in 34(43%); in 11(14%) recurrent TIA. Baseline comorbidity profile, presenting symptoms and timing of treatment were comparable between old and young patients, but the rate of preoperative cerebral infarction was lower in octogenarians: 36.2% vs. 52.5% (P=0.031).30-day stroke/death rate was 2.5% in octogenarians (2/79) and 3.4% (7/203) in younger patients (OR 0.73; 95%Cl,0.15-3.58; P=0.99).There were one 30-day death and no cerebral hemorrhage among octogenarians. No 30-day stroke/death occurred in procedures within 48h. In adjusted analyses octogenarian was not associated with increased stroke/death risk. At 4-year all cause survival was lower (58%) in octogenarians than in younger patients (91%%,P= Conclusions: Octogenarians undergoing carotid revascularization within the acute (15 days) or hyperacute (48 hours) period after TIA/stroke show 30-day stroke/death and 4-year stroke rates comparable to younger patients. Given the higher age-related risk of stroke exposure and recurrence, the benefit from an acute carotid treatment in octogenarians may be relevant.
- Published
- 2016
19. Trends in Stroke Severity and Incidence After Endovascular Repair for Descending Thoracic Aorta Diseases
- Author
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DE RANGO, Paola, Isernia, Giacomo, Simonte, Gioele, Alessandro, Marucchini, Cieri, Enrico, Luca, Farchioni, and Verzini, Fabio
- Subjects
Aortic diseasesPerioperativeStrokeSurgery - Published
- 2016
20. Tapered Stent Geometry Provides Strong Hemodynamic Effect After Carotid Stenting
- Author
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DE RANGO, Paola, Cacioppa, LAURA MARIA, Cieri, Enrico, Isernia, Giacomo, Simonte, Gioele, Massimo, Lenti, Luca, Farchioni, and Verzini, Fabio
- Subjects
Endovascular stroke treatmentStentHemodynamicsCarotid arteries - Published
- 2016
21. Arbitrary Palliation of Ruptured Abdominal Aortic Aneurysms in the Elderly is no Longer Warranted
- Author
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Fabio Verzini, Enrico Cieri, Gioele Simonte, Massimo Lenti, P. De Rango, Luca Farchioni, Alessandra Manzone, and G. Parlani
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Aortic Rupture ,Palliative treatment ,Ruptured Aortic Aneurysm ,030204 cardiovascular system & hematology ,030230 surgery ,Ruptured aortic aneurysms ,Logistic regression ,Risk Assessment ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Age Distribution ,Postoperative Complications ,0302 clinical medicine ,Aneurysm ,Elderly ,Risk Factors ,medicine ,Old patients ,Humans ,EVAR ,Prospective Studies ,Turndown ,Prospective cohort study ,Aortic rupture ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Endovascular Procedures ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Refusal ,Confidence interval ,Surgery ,Treatment Outcome ,Female ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment ,Aortic Aneurysm, Abdominal - Abstract
Objective/Background A consistent number of elderly patients with ruptured abdominal aortic aneurysms (rAAAs) are deemed unfit for repair and excluded from any treatment. The objective of this study was to examine the impact on survival of endovascular repair and open surgery with restricted turndown in acute AAA repair. Methods A prospective database for patients treated for rAAA was established. None of the patients admitted alive with rAAA were denied treatment. Multivariate regression models, the predictive risk assessment Glasgow Aneurysm Score (GAS), and subgroup analyses in older patients were applied to identify indicators of excessive 30 day mortality risk that could affect the decision for turndown. Results From 2006 to 2015, 113 consecutive patients (93 males; mean age 77.2 years) with rAAAs were treated (69 open surgery; 44 EVAR). Overall peri-operative (30 day) mortality was 38.9% (44/113): 40.6% (28/69), and 36.4% (16/44) after open surgery and EVAR, respectively ( p = .70). Multivariate logistic regression identified old age as an indicator of increased peri-operative mortality (odd ratio [OR] 1.2, 95% confidence interval [CI] 1.1–1.3; p = .001), as well as free aneurysm rupture (OR 5.0, 95% CI 1.3–19.9; p = .02). GAS was higher in patients who died (97.75 vs. 86.62), but the score failed to identify increased peri-operative mortality risk in adjusted analyses (OR 1.0; p = .06). Almost two thirds of the patients ( n = 71) were older than 75 at the time of aneurysm rupture (48.6% octogenarians) and EVAR was more commonly applied than open surgery (86.4% vs. 47.8%; p 75 year old patients was 46.5% compared with 26.2% in younger patients ( p = .05), with rates increased after open surgery (54.5% vs. 27.8%, p = .03) but not after EVAR (39.5% vs. 16.7%; p = .39). According to Kaplan–Meier estimates, mean survival was 39.7 ± 4.8 months. Patients older than 75 years of age survived for a mean of 23.0 ± 4.47 months after rupture. Conclusion In this study aggressive treatment with a very restricted or no turndown strategy for any rAAA, also applied to older patients, allowed for an additional mean 40 months of survival after aneurysm rupture. In the contemporary endovascular era the decision to deny repair arbitrarily to older patients with rAAAs must be revisited.
- Published
- 2016
22. Abstract TP124: Tapered Stent Geometry Provides Strong Hemodynamic Effect After Carotid Stenting
- Author
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Giacomo Isernia, Fabio Verzini, Luca Farchioni, Enrico Cieri, Paola De Rango, Laura Maria Cacioppa, Massimo Lenti, and Gioele Simonte
- Subjects
Advanced and Specialized Nursing ,medicine.medical_specialty ,business.industry ,Carotid arteries ,medicine.medical_treatment ,Hemodynamics ,Stent ,medicine.disease ,Endovascular stroke treatmentStentHemodynamicsCarotid arteries ,Medicine ,Neurology (clinical) ,Radiology ,Carotid stenting ,Cardiology and Cardiovascular Medicine ,business ,Stroke - Abstract
Objective: In the last years, development of materials allowed notably improvements in interventional approach to stroke. Tapered stents were specifically designed for extracranial carotid stenting (CAS) to deal with vessels mismatch decreasing the risk of thrombosis. Nevertheless, as to whether the stent geometry may affect the hemodynamic consequences of CAS remains uncertain. This study aims to investigate the impact of stent configuration on postprocedural sustained hemodynamic depression (HD) requiring action of care after carotid stenting (CAS). Methods: Data on 391 consecutive CAS performed over a 4-year period (2011-2014) were reviewed. Postprocedural sustained HD was defined as any severe hypotension (2 measurements after the end of the procedure and requiring care support or delaying hospital discharge. Stent configuration (tapered or straight) was tested for association with sustained HD using multivariable models adjusted for other confounders (medical therapy, comorbidities, symptoms, stenosis, carotid plaque and demographics).The relation with stroke and death outcomes within 30 days of treatment was also analyzed. Results: Mean age of patients was 70.7y + 7.14 and 66.2% were males. Sustained HD developed after 144 (36.8%) CAS. Tapered stents were applied in 289 (73.9%) CAS, and more frequently in patients with higher degree of stenosis (mean 79% vs 77%, in tapered and straight stents respectively; P=0.007) or asymptomatic (93.8% vs. 85.3% in tapered and straight stents respectively;P=0.012). Diabetes (HR 1.6, 95% CI, 1.01-2.44;P=0.044) and tapered stent configuration (HR, 1.7, 95% CI, 1.05-2.82;P=0.033) were the only factors that showed independent association with sustained HD. At 30-day, 3 strokes and no death occurred. There was no statistically significant association between 30-day outcomes and sustained HD depression or stent configuration. Conclusions: A strong hemodynamic effect, requiring additional actions of care or prolonged hospital stay, is expected after CAS when using tapered stent configuration. These findings alert on the overall benefit and costs of CAS and the requirements for accurate material selection especially in diabetic patients.
- Published
- 2016
23. Safety From Acute Carotid Revascularization in Octogenarians With Recently Symptomatic Carotid Stenosis
- Author
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DE RANGO, Paola, Luca, Farchioni, Alessandra, Manzone, Simonte, Gioele, Selena, Pelliccia, Cieri, Enrico, Caso, Valeria, and Massimo, Lenti
- Subjects
Acute stroke careSurgeryAgingStrokeCardiovascular disease - Published
- 2016
24. Safety of Carotid Revascularization in Symptomatic Patients with less than 70 Years
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Fabio Verzini, Alessandra Manzone, G. Parlani, Luca Farchioni, Massimo Lenti, Paola De Rango, Gioele Simonte, and Enrico Cieri
- Subjects
Carotid Artery Diseases ,Male ,Time Factors ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Carotid endarterectomy ,030204 cardiovascular system & hematology ,0302 clinical medicine ,Risk Factors ,Odds Ratio ,Stroke ,Endarterectomy, Carotid ,stroke ,carotid revascularization ,age ,symptomatic ,Incidence ,Mortality rate ,Endovascular Procedures ,Age Factors ,General Medicine ,Middle Aged ,stroke, carotid revascularization, age, symptomatic ,Treatment Outcome ,Italy ,Female ,Stents ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,Revascularization ,Risk Assessment ,Asymptomatic ,Disease-Free Survival ,03 medical and health sciences ,medicine ,Humans ,Risk factor ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Chi-Square Distribution ,business.industry ,Perioperative ,Odds ratio ,medicine.disease ,Surgery ,Multivariate Analysis ,business ,030217 neurology & neurosurgery - Abstract
Age is a main risk factor for stroke and perioperative risk. This study aims to analyze the effect of age by symptomatic status in young patients receiving carotid revascularization.Consecutive carotid revascularization procedures performed during the period 2001-2009 were reviewed. Patients were analyzed by age using the 70-year threshold as suggested by trials. Primary end point was perioperative stroke or death rate. Secondary end points included survival and late stroke incidence at 6 years.A total of 2,196 procedures (1,080 by carotid artery stenting [CAS] and 1,116 by carotid endarterectomy [CEA]) were analyzed. Symptomatic patients (n = 684) showed higher perioperative stroke or death risks (24 of 684 [3.5%] versus 29 of 1,512 [1.9%], odds ratio [OR] 1.8; 95% confidence interval [CI] 1.07-3.22; P = 0.034) and lower 6-year survival (74% vs. 82%, P0.0001) or freedom from late stroke (93% vs. 97%, P = 0.001) when compared with asymptomatic patients with similar differences detected within CEA or CAS procedure. Overall 949 procedures were in patients with 70 years or less at the time of intervention (500 CEA and 449 CAS); 282 were in patients symptomatic for minor stroke or transient ischemic attack within 6 months before revascularization. For young symptomatic patients, primary end point rates were2.5% after both CEA and CAS procedure. Perioperative stroke or death rates were 2.4% in symptomatic versus 1.5% in asymptomatic (4 of 170 vs. 5 of 330; OR 1.57; 95% CI 0.42-5.91; P = 0.50) within the CEA group and 1.8% in symptomatic versus 1.2% in asymptomatic (2 of 112 vs. 4 of 337; OR 1.51; 95% CI 0.27-8.38; P = 0.64) within the CAS group. At 6 years, symptomatic young patients showed survival (89.5% vs. 89%, P = 0.76) and freedom from late stroke (97% vs. 98%, P = 0.56) rates comparable to those found in asymptomatic patients, with similar incidences after CAS or CEA procedure.Outcomes after carotid revascularization are related to patients' age. At younger ages (70 years), after carotid revascularization, symptomatic patients show low perioperative risks of stroke or death, comparable with those in asymptomatic patients. The same, 2.5% or lower, threshold for perioperative stroke or death risk related to asymptomatic carotid procedures must be applied today to symptomatic patients when younger than age of 70 years.
- Published
- 2016
25. VH06. The Knickerbocker Technique for Endovascular Exclusion of False Lumen in Chronic Type B Aortic Dissection
- Author
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Paola De Rango, Diletta Loschi, Luca Farchioni, Fabio Verzini, Gianbattista Parlani, and Gioele Simonte
- Subjects
Aortic dissection ,medicine.medical_specialty ,knickerbocker technique ,aortic dissection ,business.industry ,Type B aortic dissection ,False lumen ,medicine.disease ,Surgery ,Medicine ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2016
26. Trends in Stroke Severity and Incidence After Endovascular Repair for Descending Thoracic Aorta Diseases
- Author
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Paola De Rango, Giacomo, Isernia, Gioele, Simonte, Alessandro, Marucchini, Enrico, Cieri, Luca, Farchioni, and Verzini, Fabio
- Subjects
Aortic diseasesPerioperativeStrokeSurgery - Published
- 2016
27. Abstract 12692: Contemporary Evidence on the Risks of Early Carotid Revascularization After Stroke in Evolution
- Author
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Michael V. Mazya, Maurizio Paciaroni, Seemant Chaturvedi, Valeria Caso, Luca Farchioni, Paola De Rango, Tudor G Jovin, Martin M. Brown, and Virginia J. Howard
- Subjects
Carotid revascularization ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Carotid endarterectomy ,medicine.disease ,Stroke in evolution ,Stenosis ,Physiology (medical) ,Internal medicine ,Ischemic stroke ,medicine ,Cardiology ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business ,Stroke ,Acute stroke - Abstract
Introduction: Current stroke guidelines suggest performing carotid endarterectomy (CEA) within 2 weeks after an ischemic stroke or TIA caused by severe carotid stenosis. However, early carotid revascularization in patients in unstable neurological condition after acute stroke (“stroke in evolution”, SIE) is controversial because of the risk of new ischemic stroke, intracerebral hemorrhage (ICH) and death. Published studies have not found a consistent benefit in this cohort. Hypothesis: The aim of this systematic review and meta-analysis was to document outcomes after urgent carotid intervention performed within 2 weeks from SIE. Methods: A systematic review of studies published in the last 8 years (2008-2015) reporting the risk of stroke, death and ICH following carotid intervention performed within 2 weeks from acute stroke in patients with SIE, was undertaken. Pooled proportion of periprocedural stroke, stroke or death and ICH were obtained with proportion meta-analysis and random effects model. Results: Out of 47 published series reporting on 2-week timing of carotid intervention after ischemic neurological event, only 15 separately described periprocedural risks for patients with SIE. In 8 studies patients underwent thrombolysis for acute stroke management of SIE before carotid revascularization. The pooled proportion of periprocedural stroke was 5.0% (95% Confidence Intervals, CI, 3.3 - 7.1), ranging 0 -14.2% among different studies. Figure. The pooled proportion of periprocedural risk for the combined of stroke or death was 4.7% (95% CI 2.9 -7.0) and that of periprocedural ICH, 1.2% (95% CI 0.4-2.4). Conclusions: The current risk of stroke, death and ICH after urgent carotid revascularization performed within 2 weeks for patients with stroke in evolution is lower than that anticipated in previous studies. Nevertheless, due to the heterogeneity in reporting and differential in patient selection, these findings should be interpreted with caution.
- Published
- 2015
28. Summary of Evidence on Early Carotid Intervention for Recently Symptomatic Stenosis Based on Meta-Analysis of Current Risks
- Author
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Seemant Chaturvedi, Michael V. Mazya, Martin M. Brown, Virginia J. Howard, Alessandra Manzone, Paola De Rango, Tudor G Jovin, Luca Farchioni, Valeria Caso, and Maurizio Paciaroni
- Subjects
Advanced and Specialized Nursing ,medicine.medical_specialty ,Endarterectomy, Carotid ,business.industry ,Mortality rate ,medicine.medical_treatment ,Carotid endarterectomy ,medicine.disease ,Risk Assessment ,Confidence interval ,Surgery ,Stenosis ,Treatment Outcome ,Internal medicine ,Meta-analysis ,Early Medical Intervention ,medicine ,Humans ,Carotid Stenosis ,Neurology (clinical) ,Carotid stenting ,Cardiology and Cardiovascular Medicine ,business ,Stroke ,Endarterectomy - Abstract
Background and Purpose— This study aimed to assess the evidence on the periprocedural ( Methods— A systematic literature review of studies published in the past 8 years reporting periprocedural stroke/death after carotid endarterectomy (CEA) and carotid stenting (CAS) related to the time between qualifying neurological symptoms and intervention was performed. Pooled estimates of periprocedural risk for patients treated within 0 to 48 hours, 0 to 7 days, and 0 to 15 days were derived with proportional meta-analyses and reported separately for patients with stroke and transient ischemic attack as index events. Results— Of 47 studies included, 35 were on CEA, 7 on CAS, and 5 included both procedures. The pooled risk of periprocedural stroke was 3.4% (95% confidence interval [CI], 2.6–4.3) after CEA and 4.8% (95% CI, 2.5–7.8) after CAS performed Conclusions— CEA within 15 days from stroke/transient ischemic attack can be performed with periprocedural stroke risk
- Published
- 2015
29. Abstract W P68: Safety of Carotid Revascularization During the Acute Period of Neurological Symptom Onset in Female Patients
- Author
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Paola De Rango, Massimo Lenti, Enrico Cieri, Luca Farchioni, Giovanbattista Parlani, Beatrice Fiorucci, and Valeria Caso
- Subjects
Advanced and Specialized Nursing ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Abstract
Background: Benefit from carotid revascularization might be lower in female patients due to increased periprocedural stroke/death risks exposure. Aim of this study was to define the 30-day risks of stroke/death after carotid endarterectomy (CEA) and carotid stenting (CAS) in symptomatic female patients treated within 15 days from last neurological event. Methods: Data of 227 consecutive patients treated during 2009-2014 by CEA or CAS within 15 days from neurological symptoms were analyzed by sex and stratified according to the delay of symptom onset. Results: There were sixty-six (29.1%) females (mean age 74.6y): 32 were treated within the first 7 days and 13 within 48hours from symptom onset. Stroke was the index event in 33 (50%), while in 17 (25.8%) recurrent TIA were recorded in the last 2 weeks before intervention. Twenty-six procedures were performed by CAS with similar rates in males and females. Baseline comorbidity profile, presenting symptoms (stroke, TIA, recurrent TIA) and timing of treatment were comparable between sexes, but there was a tendency for higher proportion of preoperative cerebral lesions in females compared to males (60.7% vs 42.8%; P=.022). The 30-day stroke and death rate was 3.0% in females (2/66) and 2.5% (4/161) in males (Odds ratio 1.27; 95% Confidence Interval, 0.27-7.12; P=.99).There were no 30-day deaths or cerebral hemorrhage in the female group. No 30-day stroke or death occurred in patients undergoing the procedure within the first 48 hours. In adjusted analyses female sex was not associated with increased stroke/death risk. At 4 years survival rates were 98% in female and 87.6% in male patients (P=.11); freedom from stroke rates were 90.1% vs. 95.5% (P=.19) in females and males, respectively. Conclusions: Female patients with symptomatic carotid stenosis may benefit from carotid intervention when performed within the acute (15 days) or hyperacute (48 hours) period after neurologic ischemic event. 30-day stroke and death rates were below or comparable to those of previous randomized trials and treatment was effective in preventing new strokes at mid-term.
- Published
- 2015
30. Abstract W P117: Risk of Carotid Revascularization During the Acute Period According to Neurological Instability
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Paola De Rango, Luca Farchioni, Massimo Lenti, Enrico Cieri, Fabio Verzini, Giovanbattista Parlani, Selena Pelliccia, and Valeria Caso
- Subjects
Advanced and Specialized Nursing ,cardiovascular diseases ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Abstract
Background: Neurological instability may increase operative risks and decrease the benefit of early carotid revascularization in patients with carotid stenosis. This study aims to define the risks after carotid revascularization performed during the acute period stratified for the presenting neurological event. Methods: Consecutive patients undergoing carotid revascularization in 2009-2014 during the acute period (within 15 days from the last neurological event) were reviewed. Thirty-day and 4-year stroke/death rates were analyzed in patients presenting with Transient Ischemic attack (TIA), recurrent TIA (more than one in the last 2 weeks before treatment) and stable stroke. Results: There were 227 patients (71% males; mean age 73.6y): 104 (45.8%) were treated after stable stroke. In 46 (20.3%) recurrent TIA were recorded before treatment. According to timing, 123 interventions were performed within the first 7 days and 36 within the first 48hours from index symptom. At 30-day there were 2 deaths, 1 fatal cerebral hemorrhage and 4 recurrent ischemic strokes. 30-day stroke/death rate was 1.6% in patients with TIA, 4.9% in patients with stroke, 4.5% in those with recurrent TIA. Multivariable analysis (backward stepwise) for 30-day stroke/death risk identified recurrent TIA presentation as the strongest independent predictor (Odds ratio,OR, 16.8; 95% Confidence Interval, CI, 1.47-191.7; P=.023), while stroke presentation was retained as a borderline statistical predictor (OR 14.8; 95%CI 0.96-228.6; P= 0.05). At 4-year, survival (86% vs. 94.9% P=.034) and freedom from stroke recurrence (90.4% vs. 97%; P=.055) rates were lower for patients with stroke presentation compared to other patients. Patients with recurrent TIA a showed comparable 4-year outcomes than other TIA patients (survival 94% vs 95% P=. 93; Stroke freedom rates 97% vs 97%; P=.86) Conclusions: For symptomatic patients undergoing carotid intervention during the acute period, presentation with recurrent TIA may expose to increased periprocedural 30-day stroke/death risk. Nevertheless, stroke remains a major marker of poorer late outcomes while recurrent TIA does not impact long-term survival and stroke recurrence.
- Published
- 2015
31. Abstract P380: The Cardiovascular Fate in Patients with Amputation or Revascularization for Critical Limb Ischemia
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Paola De Rango, Massimo Lenti, Enrico Cieri, Alessandro Marucchini, Luca Farchioni, and Alessandra Manzone
- Subjects
Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Background: Critical limb ischemia (CLI) continues to be a significantly morbid disease for the aging population with high likelihood of cardiovascular mortality and morbidity. Objective: To analyze incidence and timing of all cause and cardiovascular mortality (CM) in patients who survived after intervention for CLI. Methods: Patients consecutively discharged with diagnosis of CLI during the period 2006-2008 were re-evaluated for cardiovascular morbidity after 2 years. Patients receiving revascularization either open or endovascular and those with primary major amputation were compared with Kaplan-Meier analyses. The effect of treatment on outcome was analyzed with Cox analysis. Results: There were 257 patients (171 men, aged 74.12y), 39 treated by primary major amputation and 218 by revascularization. During a mean follow-up of 37months, 81 patients died for all cause mortality and 35 for CM. Mean survival time was 57.4months. More than half deaths (n=44) occurred by 15 months with 21 patients dying in the first 6 months and 33 within the first 12 months. Thirty-five myocardial infarctions and 15 strokes occurred. Cumulative survival rate at 60 months was 54% for all cause mortality and 79% for CM. There was significantly worse survival in patients with primary amputation when compared to those receiving revascularization: rates for all cause mortality were 45% vs. 75% (p=0.001) and rates for CM were 68% vs. 90% (p Unadjusted odd ratios for all cause and cardiovascular mortality in patients with primary amputation vs. revascularization were 3.07 (95%CI 1.5-6.1, p=0.002) and 5.25 (95%CI 2.3-11.6, p Conclusion: Mortality and CM after 2 years in patients surviving from CLI procedures are high. Primary amputation is a strong predictor of poor prognosis in the mid-long term for patients with CLI. Most deaths occur in the first 15 months after treatment. This data may question the benefits of revascularization.
- Published
- 2014
32. Abstract W P113: Periprocedural Risk of Carotid Revascularization According to Delay from Neurologic Symptom Onset During the Acute Period
- Author
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Paola De Rango, Massimo Lenti, Enrico Cieri, Andrea Ciucci, Luca Farchioni, Beatrice Fiorucci, and Valeria Caso
- Subjects
Advanced and Specialized Nursing ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Abstract
Background: Concerns on procedural risks in patients with recent transient ischemic attack (TIA) or stroke have been raised against the efficacy of early carotid revascularization performed during the acute period ( Methods: During 2009-2013, 207 consecutive patients were treated with carotid revascularization within 20 days from the last neurologic event. Thirty-day stroke/death rate was analyzed in procedures performed Results: There were 183 CEA and 24 CAS. Overall 175 procedures were performed within the first 15 days and 32 after. Specifically, 22 patients were treated within the first 48h and 89 within the first 7 days. The 30-day stroke and death rate was 2.9% (6/207). There were 3 deaths, 2 cerebral hemorrhages and 3 ischemic strokes. 30-day stroke/death rate was comparable in patients treated within the first 15 days and those treated later : 2.9% (5/175) and 3.1% (1/32); Odds ratio , OR 0.9; 95%Confidence Interval, CI, 0.10-8.1; p=.99. 30-day stroke/death rate was 2.2% (2/89) for patients treated within 7 days and 3.5% (3/86) for those treated between 7 and 15 days. For the 22 patients receiving carotid revascularization within the first 48 hours, periprocedural risk was 0. Conclusions: Currently carotid revascularization can be performed safely within the acute period from neurologic symptoms onset with a stroke/death risk of 3.5% or lower.
- Published
- 2014
33. Five Years Results of Aortic Arch Debranching
- Author
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Paola De Rango, Enrico Cieri, Carlo Coscarella, Ciro Ferrer, Piergiorgio Cao, Luca Farchioni, Gioele Simonte, Fabio Verzini, and Gianbattista Parlani
- Subjects
Aortic arch ,medicine.medical_specialty ,debranching stroke aortic arc ,business.industry ,medicine.artery ,medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2013
34. Lesson Learned with the Use of Iliac Branch Devices: 10 Year Results in 150 Consecutive Patients
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Massimo Lenti, G. Parlani, Enrico Cieri, Piergiorgio Cao, Giacomo Isernia, Luca Farchioni, Fabio Verzini, and Gioele Simonte
- Subjects
medicine.medical_specialty ,business.industry ,General surgery ,medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2016
35. Abstract 5: Early and Long-term Safety of Stenting and Endarterectomy in Symptomatic and Asymptomatic Patients Outside Randomized Trials
- Author
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Enrico Cieri, Giuseppe Giordano, Gioele Simonte, Luca Farchioni, Massimo Lenti, Fabio Verzini, Paola De Rango, and Piergiorgio Cao
- Subjects
Advanced and Specialized Nursing ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Mortality rate ,Carotid arteriesAngioplastySurgeryStrokePrevention ,medicine.disease ,Asymptomatic ,Surgery ,Angioplasty ,medicine ,Neurology (clinical) ,medicine.symptom ,Carotid stenting ,Cardiology and Cardiovascular Medicine ,Complication ,business ,Survival rate ,Stroke ,Endarterectomy - Abstract
Objective. Due to the different stroke risk exposure, advisability of carotid revascularization by carotid stenting (CAS) or endarterectomy (CEA) strictly depends on patients’ symptomatic status. Periprocedural and 5-year data of 2196 consecutive procedures (1080 CAS, 1116 CEA) based on physician-guided indication for CEA vs CAS and performed after training outside randomized trials, were reviewed for safety. Methods. 684 symptomatic and 1512 asymptomatic patients were analyzed for periprocedural stroke/death and 5-year death or stroke incidence. Kaplan-Meier survival curves with type-of-procedure interaction were employed. Results. Symptomatic patients were older (71.9y vs 71.04y), less frequently females (25.3% vs 30.8%) and treated more by CEA (60.8%) than by CAS (p Conclusions. Symptomatic patients show higher risks after carotid revascularization and 5-year outcomes are inferior to those of asymptomatic patients regardless of the surgical procedure. Periprocedural stroke/death rates, either by CAS or CEA, are within the complication threshold rates suggested in current guidelines for both symptomatic and asymptomatic patients.
- Published
- 2012
36. Percutaneous approach in the maintenance and salvage of dysfunctional autologous vascular access for dialysis
- Author
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Fabio Verzini, Alessandra Manzone, Paola De Rango, Luca Farchioni, Basso Parente, Paolo Bonanno, and Enrico Cieri
- Subjects
Male ,BALLOON ANGIOPLASTY ,Time Factors ,medicine.medical_treatment ,Constriction, Pathologic ,Kaplan-Meier Estimate ,Single Center ,Prospective Studies ,Aged, 80 and over ,FISTULAS ,Graft Occlusion, Vascular ,Health Care Costs ,Middle Aged ,Treatment Outcome ,Nephrology ,PRACTICE GUIDELINES ,PLACEMENT ,GRAFTS ,Female ,Adult ,Reoperation ,medicine.medical_specialty ,Maintenance ,Vascular access ,SOCIETY ,Dysfunctional family ,STENOSES ,Anastomosis ,PRESSURE ,Young Adult ,Arteriovenous Shunt, Surgical ,Renal Dialysis ,Angioplasty ,medicine ,Humans ,Dialysis ,Vascular Patency ,Aged ,business.industry ,medicine.disease ,Surgery ,Radiography ,Stenosis ,Vascular access ARTERIOVENOUS HEMODIALYSIS ACCESS ,Balloon ,Complication ,business ,Angioplasty, Balloon - Abstract
PURPOSE Endovascular procedures have been increasingly used for salvage of failing vascular access with conflicting results. The aim of this study was to assess the mid-term patency and complication rates of angioplasty procedures performed in a single center for treatment of stenosis compromising vascular accesses. METHODS A prospective database of vascular accesses performed in 2006-2010 was investigated. The endovascular approach was applied following a standardized protocol by a dedicated team. A total of 531 consecutive procedures were reviewed (326 men; mean age 70.94 years). Patency rates were estimated using the Kaplan-Meier method. RESULTS There were 199 procedures for failing access: 135 were surgical and 64 angioplasties performed for anastomosis (n=27), venous (n=45) or arterial (n=7) stenosis. Immediate technical success of endovascular procedures was 95.3%(61/64); complication rate was 6.3% (4/64). Primary patency rates were 55% at six months, 49% at 12 months, and 21% at 24 months. In the concurrent group of 135 open procedures, primary patency rates were 80% at six months and 67% at 12 months (P=.002); nevertheless, at 24 months, patency was as low as 49%. Cost estimates for angioplasty revealed additional fees ranging from 411.34 to 446.34 Euro with respect to open surgical procedures. CONCLUSIONS Most dysfunctional vascular accesses can be successfully and safely treated by the endovascular route. In spite of poor mid-term durability, the angioplasty balloon might be considered as a bridge, effective, and repeatable solution with reasonable costs to prolong access survival avoiding additional surgery. The failure rate in the mid-term for dysfunctional vascular access may also be high after surgical reintervention.
- Published
- 2012
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