Search

Your search keyword '"Nicola Troisi"' showing total 159 results
Start Over Author "Nicola Troisi"
159 results on '"Nicola Troisi"'

1. Editorial: Modern management of ruptured abdominal aortic aneurysm

Author

Harm Pieter Ebben, Petar Zlatanovic, Desiree van den Hondel, Vishal Amlani, Mario Giovanni Gerardo D’Oria, Nicola Troisi, and Albert Bush

Subjects
RAAA, ruptured abdominal aorta aneurysm, EVAR, OSR, acute aortic syndrome, ruptured aneurysm, Diseases of the circulatory (Cardiovascular) system, RC666-701
Published
2024
Full Text
View/download PDF

2. Kissing intravascular lithotripsy in iliac in-stent restenosis related to underexpanded stents

Author

Nicola Troisi, MD, Francesco Canovaro, MD, Daniele Adami, MD, Vittorio Malquori, MD, and Raffaella Berchiolli, MD

Subjects
Chronic limb-threatening ischemia, In-stent restenosis, Intravascular lithotripsy, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Intravascular lithotripsy (IVL) has been used for the treatment of native highly calcified arterial lesions. No data are available in the literature about its use in the treatment of noncoronary in-stent restenosis (ISR). We report the case of kissing IVL in highly calcified iliac ISR related to underexpansion of stents previously deployed in the common iliac arteries. The procedures were performed with a combined percutaneous right femoral and surgical left axillary access. This case demonstrates the safety and effectiveness of IVL even for the treatment of iliac ISR when other “standard” techniques cannot be used to obtain a satisfactory outcome. This technique needs to be evaluated further with multicenter experiences and adequate population sizes.

Published
2024
Full Text
View/download PDF

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

Author

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

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701, Surgery, RD1-811
Published
2024
Full Text
View/download PDF

4. Successful extreme foot revascularization with plaque cracking (percutaneous direct needle puncture of calcified plaque) technique of medial tarsal artery

Author

Nicola Troisi, MD, Francesco Canovaro, MD, Daniele Adami, MD, and Raffaella Berchiolli, MD

Subjects
Below-the-ankle, PIERCE technique, Retrograde access, Tarsal artery, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

The percutaneous direct needle puncture of calcified plaque technique is a valuable method to allow for extreme revascularization of occluded below-the-ankle vessels. We report the case of an antegrade recanalization technique from the peroneal artery to medial plantar artery to achieve external “cracking” of a calcified plaque of the medial tarsal artery.

Published
2023
Full Text
View/download PDF

5. A technical review of bail-out procedures to place Najuta stent-graft into the ascending aorta

Author

Raffaella Berchiolli, Nicola Troisi, Giulia Bertagna, Andrea Colli, Laura Besola, Roberto Silingardi, Gioele Simonte, Giacomo Isernia, and Italian Najuta registry collaborators

Subjects
Najuta stent-graft, Aortic arch, Thoracic endovascular aortic repair (TEVAR), Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background The Najuta stent-graft (Kawasumi Laboratories Inc., Tokyo, Japan) is usually easily advanced to the correct deployment position in the ascending aorta thanks to the pre-curved delivery J-sheath with all fenestrations automatically oriented towards the supra-aortic vessels. Aortic arch anatomy and delivery system stiffness could however represent limitations for proper endograft advancement, especially when the aortic arch bends sharply. The aim of this technical note is to report a series of bail-out procedures that could be useful to overcome the difficulties encountered during the Najuta stent-graft advancement up to the ascending aorta. Main body The insertion, positioning and deployment of a Najuta stent-graft requires a through-and-through guidewire technique using a .035″ 400 cm hydrophilic nitinol guidewire (Radifocus™ Guidewire M Non-Vascular, Terumo Corporation, Tokyo, Japan) with right brachial and both femoral accesses. When standard maneuver to put the endograft tip into the aortic arch, some bail-out procedures can be applied to obtain proper positioning. Five techniques are described into the text: positioning of a coaxial extra-stiff guidewire; positioning of a long introducer sheath down to the aortic root from the right brachial access; inflation of a balloon inside the ostia of the supra-aortic vessels; inflation of a balloon inside the aortic arch (coaxial to the device); and transapical access technique. This is a troubleshooting guide for allowing physicians to overcome various difficulties with the Najuta endograft as well as for other similar devices. Short conclusion Technical issues in advancing the delivery system of Najuta stent-graft could occur. Therefore, the rescue procedures described in this technical note could be useful to guarantee the correct positioning and deployment of the stent-graft.

Published
2023
Full Text
View/download PDF

6. Intraoperative Predictors and Proposal for a Novel Prognostic Risk Score for In-Hospital Mortality after Open Repair of Ruptured Abdominal Aortic Aneurysms (SPARTAN Score)

Author

Raffaella Berchiolli, Nicola Troisi, Giulia Bertagna, Mario D’Oria, Luca Mezzetto, Vittorio Malquori, Valerio Artini, Duilio Motta, Lorenzo Grosso, Beatrice Grando, Giovanni Badalamenti, Cristiano Calvagna, Davide Mastrorilli, Gian Franco Veraldi, Daniele Adami, and Sandro Lepidi

Subjects
ruptured abdominal aortic aneurysm, open surgical repair, intraoperative scores, Medicine
Abstract

(1) Background: Several mortality risk scores have been developed to predict mortality in ruptured abdominal aortic aneurysms (rAAAs), but none focused on intraoperative factors. The aim of this study is to identify intraoperative variables affecting in-hospital mortality after open repair and develop a novel prognostic risk score. (2) Methods: The analysis of a retrospectively maintained dataset identified patients who underwent open repair for rAAA from January 2007 to October 2023 in three Italian tertiary referral centers. Multinomial logistic regression was used to calculate the association between intraoperative variables and perioperative mortality. Independent intraoperative factors were used to create a prognostic score. (3) Results: In total, 316 patients with a mean age of 77.3 (SD ± 8.5) were included. In-hospital mortality rate was 30.7%. Hemoperitoneum (p < 0.001), suprarenal clamping (p = 0.001), and operation times of >240 min (p = 0.008) were negative predictors of perioperative mortality, while the patency of at least one hypogastric artery had a protective role (p = 0.008). Numerical values were assigned to each variable based on the respective odds ratio to create a risk stratification for in-hospital mortality. (4) Conclusions: rAAA represents a major cause of mortality. Intraoperative variables are essential to estimate patients’ risk in surgically treated patients. A prognostic risk score based on these factors alone may be useful to predict in-hospital mortality after open repair.

Published
2024
Full Text
View/download PDF

7. Peripheral Interventional Strategy Assessment (PISA) for Diabetic Foot Ulcer Revascularization: Preliminary Outcomes of a Multidisciplinary Pilot Study

Author

Raffaella Berchiolli, Giulia Bertagna, Daniele Adami, Alberto Piaggesi, Elisabetta Iacopi, Francesco Giangreco, Lorenzo Torri, and Nicola Troisi

Subjects
chronic limb-threatening ischemia, duplex ultrasonography, lower limb revascularization, Medicine (General), R5-920
Abstract

Background: Digital subtraction angiography (DSA) still represents the gold standard for anatomical arterial mapping and revascularization decision-making in patients with chronic limb-threatening ischemia (CLTI), although DUS (Doppler Ultrasound) remains a primary non-invasive examination tool. The Global Vascular Guidelines established the importance of preoperative arterial mapping to guarantee an adequate in-line flow to the foot. The aim of this study was to evaluate the accuracy of DUS in guiding therapeutic vascular treatments on the basis of Global Vascular Guidelines without the need of a second-level examination. Methods: Between January 2022 and June 2022, all consecutive patients with CLTI to be revascularized underwent clinical examination and DUS without further diagnostic examinations. Primary outcomes assessed were technical success, and 30-day mortality. Secondary outcomes were 1-year amputation free survival, and time between evaluation and revascularization. Results: Sixty-eight patients with a mean age of 73.6 ± 8.5 years underwent lower limb revascularization. Technical success was 100%, and the 30-day mortality rate was 2.9%. Mean time between evaluation and revascularization was 29 ± 17 days. One-year amputation free survival was 97.1%. Conclusions: DUS without further diagnostic examinations can accurately assess the status of the vascular tree and foot runoff, providing enough information about target vessels to guide revascularization strategies.

Published
2023
Full Text
View/download PDF

8. Risk Prediction Models for Peri-Operative Mortality in Patients Undergoing Major Vascular Surgery with Particular Focus on Ruptured Abdominal Aortic Aneurysms: A Scoping Review

Author

Alessandro Grandi, Luca Bertoglio, Sandro Lepidi, Tilo Kölbel, Kevin Mani, Jacob Budtz-Lilly, Randall DeMartino, Salvatore Scali, Lydia Hanna, Nicola Troisi, Cristiano Calvagna, and Mario D’Oria

Subjects
vascular surgery, peri-operative mortality, risk models, scoping review, ruptured AAA, Medicine
Abstract

Purpose. The present scoping review aims to describe and analyze available clinical data on the most commonly reported risk prediction indices in vascular surgery for perioperative mortality, with a particular focus on ruptured abdominal aortic aneurysm (rAAA). Materials and Methods. A scoping review following the PRISMA Protocols Extension for Scoping Reviews was performed. Available full-text studies published in English in PubMed, Cochrane and EMBASE databases (last queried, 30 March 2023) were systematically reviewed and analyzed. The Population, Intervention, Comparison, Outcome (PICO) framework used to construct the search strings was the following: in patients with aortic pathologies, in particular rAAA (population), undergoing open or endovascular surgery (intervention), what different risk prediction models exist (comparison), and how well do they predict post-operative mortality (outcomes)? Results. The literature search and screening of all relevant abstracts revealed a total of 56 studies in the final qualitative synthesis. The main findings of the scoping review, grouped by the risk score that was investigated in the original studies, were synthetized without performing any formal meta-analysis. A total of nine risk scores for major vascular surgery or elective AAA, and 10 scores focusing on rAAA, were identified. Whilst there were several validation studies suggesting that most risk scores performed adequately in the setting of rAAA, none reached 100% accuracy. The Glasgow aneurysm score, ERAS and Vancouver score risk scores were more frequently included in validation studies and were more often used in secondary studies. Unfortunately, the published literature presents a heterogenicity of results in the validation studies comparing the different risk scores. To date, no risk score has been endorsed by any of the vascular surgery societies. Conclusions. The use of risk scores in any complex surgery can have multiple advantages, especially when dealing with emergent cases, since they can inform perioperative decision making, patient and family discussions, and post hoc case-mix adjustments. Although a variety of different rAAA risk prediction tools have been published to date, none are superior to others based on this review. The heterogeneity of the variables used in the different scores impairs comparative analysis which represents a major limitation to understanding which risk score may be the “best” in contemporary practice. Future developments in artificial intelligence may further assist surgical decision making in predicting post-operative adverse events.

Published
2023
Full Text
View/download PDF

9. The Management of Ruptured Abdominal Aortic Aneurysms: An Ongoing Challenge

Author

Nicola Troisi, Giulia Bertagna, Lorenzo Torri, Francesco Canovaro, Mario D’Oria, Daniele Adami, and Raffaella Berchiolli

Subjects
ruptured abdominal aortic aneurysm, open surgical repair, endovascular repair, high-volume center, preoperative scores, Medicine
Abstract

Background: despite improvements in the diagnosis and treatment of elective AAAs, ruptured abdominal aortic aneurysms (RAAAs) continue to cause a substantial number of deaths. The choice between an open or endovascular approach remains a challenge, as does postoperative complications in survivors. The aim of this manuscript is to offer an overview of the contemporary management of RAAA patients, with a focus on preoperative and intraoperative factors that could help surgeons provide more appropriate treatment. Methods: we performed a search on MEDLINE, Embase, and Scopus from 1 January 1985 to 1 May 2023 and reviewed SVS and ESVS guidelines. A total of 278 articles were screened, but only those with data available on ruptured aneurysms’ incidence and prevalence, preoperative scores, and mortality rates after emergency endovascular or open repair for ruptured AAA were included in the narrative synthesis. Articles were not restricted due to the designs of the studies. Results: the centralization of RAAAs has improved outcomes after both surgical and endovascular repair. Preoperative mortality risk scores and knowledge of intraoperative factors influencing mortality could help surgeons with decision-making, although there is still no consensus about the best treatment. Complications continue to be an issue in patients surviving intervention. Conclusions: RAAA still represents a life-threatening condition, with high mortality rates. Effective screening and centralization matched with adequate preoperative risk–benefit assessment may improve outcomes.

Published
2023
Full Text
View/download PDF

10. Bioengineering, augmented reality, and robotic surgery in vascular surgery: A literature review

Author

Sara Condino, Roberta Piazza, Marina Carbone, Jonathan Bath, Nicola Troisi, Mauro Ferrari, and Raffaella Berchiolli

Subjects
biomedical engineering, vascular surgery, endovascular surgery, augmented reality, robotic surgery, Surgery, RD1-811
Abstract

Biomedical engineering integrates a variety of applied sciences with life sciences to improve human health and reduce the invasiveness of surgical procedures. Technological advances, achieved through biomedical engineering, have contributed to significant improvements in the field of vascular and endovascular surgery. This paper aims to review the most cutting-edge technologies of the last decade involving the use of augmented reality devices and robotic systems in vascular surgery, highlighting benefits and limitations. Accordingly, two distinct literature surveys were conducted through the PubMed database: the first review provides a comprehensive assessment of augmented reality technologies, including the different techniques available for the visualization of virtual content (11 papers revised); the second review collects studies with bioengineering content that highlight the research trend in robotic vascular surgery, excluding works focused only on the clinical use of commercially available robotic systems (15 papers revised). Technological flow is constant and further advances in imaging techniques and hardware components will inevitably bring new tools for a clinical translation of innovative therapeutic strategies in vascular surgery.

Published
2022
Full Text
View/download PDF

11. Chronic Limb-Threatening Ischemia and the Need for Revascularization

Author

Raffaella Berchiolli, Giulia Bertagna, Daniele Adami, Francesco Canovaro, Lorenzo Torri, and Nicola Troisi

Subjects
chronic limb-threatening ischemia, peripheral arterial disease, lower-limb revascularization, peripheral bypass, endovascular treatment, Medicine
Abstract

Background: Patients presenting with critical limb-threatening ischemia (CLTI) have been increasing in number over the years. They represent a high-risk population, especially in terms of major amputation and mortality. Despite multiple guidelines concerning their management, it continues to be challenging. Decision-making between surgical and endovascular procedures should be well established, but there is still a lack of consensus concerning the best treatment strategy. The aim of this manuscript is to offer an overview of the contemporary management of CLTI patients, with a focus on the concept that evidence-based revascularization (EBR) could help surgeons to provide more appropriate treatment, avoiding improper procedures, as well as too-high-risk ones. Methods: We performed a search on MEDLINE, Embase, and Scopus from 1 January 1995 to 31 December 2022 and reviewed Global and ESVS Guidelines. A total of 150 articles were screened, but only those of high quality were considered and included in a narrative synthesis. Results: Global Vascular Guidelines have improved and standardized the way to classify and manage CLTI patients with evidence-based revascularization (EBR). Nevertheless, considering that not all patients are suitable for revascularization, a key strategy could be to stratify unfit patients by considering both clinical and non-clinical risk factors, in accordance with the concept of individual residual risk for every patient. The recent BEST-CLI trial established the superiority of autologous vein bypass graft over endovascular therapy for the revascularization of CLTI patients. However, no-option CLTI patients still represent a critical issue. Conclusions: The surgeon’s experience and skillfulness are the cornerstones of treatment and of a multidisciplinary approach. The recent BEST-CLI trial established that open surgical peripheral vascular surgery could guarantee better outcomes than the less invasive endovascular approach.

Published
2023
Full Text
View/download PDF

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

Author

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

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

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

Published
2023
Full Text
View/download PDF

13. [18F]-Fludeoxyglucose Positron Emission Tomography/Computed Tomography with Radiomics Analysis in Patients Undergoing Aortic In-Situ Reconstruction with Cryopreserved Allografts

Author

Raffaella Berchiolli, Lorenzo Torri, Giulia Bertagna, Francesco Canovaro, Roberta Zanca, Francesco Bartoli, Davide Maria Mocellin, Mauro Ferrari, Paola Anna Erba, and Nicola Troisi

Subjects
cryopreserved allograft, radiomics, FDG-PET/CT, aortic in situ reconstruction, Medicine (General), R5-920
Abstract

Background: The aim of this study was to evaluate the effectiveness of positron emission tomography/computed tomography with [18F]-fludeoxyglucose (FDG-PET/CT) and radiomics analysis in detecting differences between the native aorta and the abdominal aortic allograft after the total eradication of infection in patients undergoing infected graft removal and in situ reconstruction with cryopreserved allografts. Methods: Between January 2008 and December 2018, 56 vascular reconstructions with allografts have been performed at our department. The present series included 12 patients undergoing abdominal aortic in situ reconstruction with cryopreserved allografts. During the follow-up, all patients underwent a total-body [18F]FDG PET/CT with subsequent radiomics analysis. In all patients, a comparative analysis between the data extracted from native aorta and cryopreserved graft for each patient was performed. Results: All patients were male with a mean age of 72.8 years (range 63–84). Mean duration of follow-up was 51.3 months (range 3–120). During the follow-up, 2 patients (16.7%) needed a redo allograft-related surgical intervention. Overall, the rate of allograft dilatation was 33.3%. No patient had a redo infection during the follow-up. Radiomics analysis showed a different signature of implanted allograft and native aorta. Comparative analysis between the native aortas and cryopreserved allografts (dilated or not) showed several statistical differences for many texture features. Conclusions: The higher metabolic activity of allografts could indicate a state of immune-mediated degeneration. This theory should be proven with prospective, multicentric studies with larger sample sizes.

Published
2022
Full Text
View/download PDF

15. Pharmacological therapy in critically ill patients with peripheral and concomitant arteriopathy

Author

Nicola Troisi, Antonio Trani, and Pierluigi Antonino Cappiello

Subjects
Peripheral arteriopathy, Cilostazol, Iloprost, Cardiovascular risk, Medicine
Abstract

Peripheral arterial disease is one of the most frequent clinical manifestations of atherosclerotic disease. The clinical picture of critical ischemia of the lower limbs is often burdened by high mortality and the risk of limb amputation. The direct and indirect prostanoids, and in particular iloprost and cilostazol, are effective in the medical treatment of peripheral arterial disease. We describe here five clinical cases in which iloprost and cilostazol have been successfully administered in arterial patients with various concomitant cardiovascular diseases, highlighting a good safety profile in relation to the cardiocascular risk profile (Cardiology).

Published
2018
Full Text
View/download PDF

16. Role of matrix metalloproteinase in the aneurismatic aortic disease

Author

Nicola Troisi, Alfredo Mazza, Felice Mazza, and Gabriele Iannelli

Subjects
Matrix metalloproteinases, aortic aneurysms, endoleak, doxycycline, Medicine
Abstract

The aorta is involved in a large variety of diseases and the atherosclerotic aneurysms represent the most common type of these. Recent reports have attempted to clarify the mechanisms, that cause the formation and the progression of the atherosclerotic aneurysms, caused not only by the atherosclerosis. One of the features of this disease is the extensive proteolytic destruction of structural matrix proteins in the aortic wall realized by the matrix metalloproteinases. The atherosclerotic aneurysm can be considered a disease caused by an imbalance between connective tissue destruction and its repair. Knowledge of the role played by matrix metalloproteinases in the formation process of the aneurysms has made the inhibition of these proteins a logical therapeutic strategy. Once completed the aneurysm treatment, surgical or endovascular, the endothelial damage must disappear; the persistence of this damage, after endovascular procedure, is the cause of the formation of the endoleaks. The preoperative matrix metalloproteinases plasmatic levels are related to the aneurysm diameter and after endovascular treatment these values come back normal, except in the case of presence of an endoleak, that don’t make possible the reduction of these values. In spite of that, obscure points still remain, above all about the dosage of these proteins and their inhibition through drugs with clear metalloproteinases- inhibiting properties. The aim of this study is to clarify further on the mechanisms of the formation of the aneurysms with particular care to the matrix metalloproteinases, their dosage and their drug inhibition.

Published
2004
Full Text
View/download PDF

17. Comparison of long occlusive femoropopliteal de novo versus previous endovascularly treated lesions managed with in situ saphenous bypass

Author

Nicola Troisi, Stefano Michelagnoli, Daniele Adami, Raffaella Berchiolli, Federico Accrocca, Alessio Amico, Andrea Angelini, Luca Arnuzzo, Andrea Ascoli Marchetti, Luca Attisani, Gennaro Bafile, Giuseppe Baldino, Enrico Barbanti, Stefano Bartoli, Raffaello Bellosta, Filippo Benedetto, Raoul Borioni, Franco Briolini, Cristina Busoni, Stefano Camparini, Pierluigi Cappiello, Luciano Carbonari, Francesco Casella, Giovanni Celoria, Andrea Chiama, Emiliano Chisci, Efrem Civilini, Francesco Codispoti, Barbara Conti, Giovanni Coppi, Giovanni De Blasis, Marcello D’Elia, Rossella Di Domenico, Carla Di Girolamo, Leonardo Ercolini, Alessandra Ferrari, Mauro Ferrari, Enzo Forliti, Paolo Frigatti, Dalmazio Frigerio, Pierfrancesco Frosini, Luca Garriboli, Antonio Nicola Giordano, Walter Guerrieri, Antonio Jannello, Mafalda Massara, Maurizio Merlo, Roberto Mezzetti, Tommaso Miccoli, Domenico Milite, Pietro Mingazzini, Marina Muncinelli, Giovanni Nano, Marco Natola, Claudio Novali, Giancarlo Palasciano, Reinhold Perkmann, Federica Persi, David Petruccelli, Mauro Pinelli, Giorgio Poletto, Carla Porta, Carlo Pratesi, Gianguido Pruner, Giovanni Ragazzi, Paolo Righini, Mauro Salvini, Paolo Scovazzi, Carlo Setacci, Alberto Maria Settembrini, Andrea Siani, Roberto Silingardi, Antonino Silvestro, Francesco Talarico, Valerio Tolva, Antonio Trani, Santi Trimarchi, Yamume Tshomba, Gennaro Vigliotti, Daniela Viola, Pietro Volpe, and Federico Zani

Subjects
in situ saphenous vein, Critical limb-threatening ischemia, In situ saphenous vein, Limb salvage, Peripheral bypass, Humans, Ischemia, Limb Salvage, Popliteal Artery, Prosthesis Design, Retrospective Studies, Saphenous Vein, Treatment Outcome, Vascular Patency, Blood Vessel Prosthesis, Femoral Artery, critical limb-threatening ischaemia, limb salvage, peripheral bypass, Settore MED/22 - Chirurgia Vascolare, Settore MED/22, Surgery, Cardiology and Cardiovascular Medicine
Abstract

The aim of this study was to compare the 2-year outcomes of de novo versus postendovascular lesion treatment of femoropopliteal occlusions included in a national, multicenter, observational, prospective registry based on the treatment of critical Limb-threatening IschaeMia with infragenicular Bypass adopting in situ SAphenous VEin technique (LIMBSAVE) registry.From January 2018 to December 2019, 541 patients from 43 centers have been enrolled in the LIMBSAVE registry. Of these patients, 460 were included in the present study: 341 (74.1%) with de novo lesions (DN group) and 119 (25.9%) with postendovascular treatment lesions (PE group). Initial outcome measures were assessed at 30 days after treatment. Furthermore, at the 2-year follow-up, the estimated outcomes of primary patency, primary-assisted patency, secondary patency, and limb salvage were analyzed with Kaplan-Meier curves and compared between groups with the log-rank test.Both groups were homogeneous in terms of demographic data, preoperative risk factors, and clinical presentation. However, compared with DN group, more patients in PE group had a great saphenous vein diameter of less than 3 mm (11.1% vs 21%; P = .007). Intraoperatively, both groups showed similar distal anastomosis sites: below-the-knee popliteal artery (63% DN group, 66.4% PE group) and tibial vessel (37% DN group, 33.6% PE group) (P = .3). The overall mean duration of follow-up was 11.6 months (range, 1-24 months). At the 2-year follow-up, there were no differences between the two groups in terms of primary patency (66.3% DN group vs 74.1% PE group; P = .9), primary-assisted patency (78.2% DN group vs 79.5% PE group; P = .2), secondary patency (85.1% DN group vs 91.4% PE group; P = .2), and limb salvage (95.2% DN group vs 95.1% PE group; P = .9).The LIMBSAVE registry did not show a worsening of overall patency and limb salvages rates at the 2-year follow-up in patients undergoing in situ saphenous bypass after a failed endovascular approach for long femoropopliteal occlusive disease. This finding is in contrast with what has been published in literature.

Published
2022

19. Timing to Carotid Endarterectomy Affects Early and Long Term Outcomes of Symptomatic Carotid Stenosis

Author

Emiliano Chisci, Elisa Lazzeri, Fabrizio Masciello, Nicola Troisi, Filippo Turini, Patrizia Lo Sapio, Luciana Tramacere, Massimo Cincotta, Alberto Fortini, Cristina Baruffi, and Stefano Michelagnoli

Subjects
Stroke, Endarterectomy, Carotid, Time Factors, Treatment Outcome, Ischemic Attack, Transient, Risk Factors, Humans, Carotid Stenosis, Surgery, General Medicine, Cardiology and Cardiovascular Medicine, Retrospective Studies
Abstract

The aim of this study is to evaluate early and long-term outcomes according to the timing to carotid endarterectomy (CEA) of symptomatic carotid stenosis.Consecutive CEAs with selective shunting for symptomatic carotid stenosis ≥50% performed between 2009 and 2020. Patients had acute neurological impairment on presentation, defined as5 points on the National Institutes of Health Stroke Scale (NIHSS). We grouped patients according to time between index event and CEA: the first group was operated between 0 and 2 days, the second group between 3 and 7 days, the third group between 8 and 14 days and the last group after 15 days. Thirty-day neurological status improvement was defined as a decrease (≥1) in the 30-day NIHSS score versus NIHSS score immediately before surgery.Five hundred CEAs were performed. The perioperative combined stroke and mortality rate was 3.6% (18/500), representing a perioperative mortality rate of 0.2 (n = 1) and stroke rate of 3.4% (n = 17). Overall freedom from stroke was 95% at 1 year, 89 % at 6 years, and 88% at 10 years. Annual stroke rate was 0.6% after the 30-day period. Thirty-day improvement in neurologic status occurred in 103 patients (20.6%), while in 380 (76%) neurologic status was unchanged, and 17 (3.4%) experienced worsening of their neurologic status. Patients treated within 7 days from the index event had significant benefit (OR = 2.6) in the 30-day neurological improvement versus those treated after 7 days from the index event. Timing to CEA2 days increased significantly the risk of late stroke (OR = 9.7).The ideal timing for performing CEA is between 3 and 7 days from the index event if NIHSS5 as it is associated with the best rates of improvement in neurological status and durability in the long term. Very early CEA (48 hrs) was associated with increased late stroke occurrence.

Published
2022

22. A technical review of bail-out procedures to place Najuta stent-graft into the ascending aorta

Author

Diego Moniaci and Nicola TROISI

Subjects
Radiology, Nuclear Medicine and imaging, Cardiology and Cardiovascular Medicine
Abstract

Background The Najuta stent-graft (Kawasumi Laboratories Inc., Tokyo, Japan) is usually easily advanced to the correct deployment position in the ascending aorta thanks to the pre-curved delivery J-sheath with all fenestrations automatically oriented towards the supra-aortic vessels. Aortic arch anatomy and delivery system stiffness could however represent limitations for proper endograft advancement, especially when the aortic arch bends sharply. The aim of this technical note is to report a series of bail-out procedures that could be useful to overcome the difficulties encountered during the Najuta stent-graft advancement up to the ascending aorta. Main body The insertion, positioning and deployment of a Najuta stent-graft requires a through-and-through guidewire technique using a .035″ 400 cm hydrophilic nitinol guidewire (Radifocus™ Guidewire M Non-Vascular, Terumo Corporation, Tokyo, Japan) with right brachial and both femoral accesses. When standard maneuver to put the endograft tip into the aortic arch, some bail-out procedures can be applied to obtain proper positioning. Five techniques are described into the text: positioning of a coaxial extra-stiff guidewire; positioning of a long introducer sheath down to the aortic root from the right brachial access; inflation of a balloon inside the ostia of the supra-aortic vessels; inflation of a balloon inside the aortic arch (coaxial to the device); and transapical access technique. This is a troubleshooting guide for allowing physicians to overcome various difficulties with the Najuta endograft as well as for other similar devices. Short conclusion Technical issues in advancing the delivery system of Najuta stent-graft could occur. Therefore, the rescue procedures described in this technical note could be useful to guarantee the correct positioning and deployment of the stent-graft.

Published
2023

23. A comparative analysis of anatomical variations of popliteal artery and its branches in concomitant aneurysmal disease

Author

Simone Panci, Emiliano Chisci, Alberto Melani, Claudio Raspanti, Carlo Pratesi, Nicola Troisi, and Stefano Michelagnoli

Subjects
medicine.medical_specialty, education.field_of_study, Surgical approach, medicine.diagnostic_test, business.industry, Population, General Medicine, Popliteal artery, Surgery, Homogeneous, Concomitant, medicine.artery, Aneurysmal disease, medicine, Radiology, Nuclear Medicine and imaging, Presentation (obstetrics), Cardiology and Cardiovascular Medicine, business, education, Computed tomography angiography
Abstract

Objectives Open or endovascular treatment of popliteal artery aneurysms (PAAs) is still debated. Data about the popliteal artery anatomy and its branches are essential to plan a surgical approach. The aim of this study was to report the anatomical variations of the popliteal artery and its branches in a population with aneurysmal disease and compare them with a standard population with non-aneurysmal disease. Methods A retrospective review of consecutive patients who underwent surgical PAA repair in our center between January 2011 and December 2020 was performed. One-hundred-forty-six limbs in 128 patients underwent PAA treatment (Group 1). Computed tomography angiography images using a 128-section configuration were reviewed for anatomical variations of the popliteal artery and its branches. A control population of 178 limbs in 89 patients with non-aneurysmal disease was used to compare the outcomes (Group 2). All limbs were classified according to Kim’s classification. The two groups were analyzed and compared by means of nonparametric Pearson chi-square test. Results Both groups were homogeneous in terms of demographics, risk factors, and clinical presentation. In Group 1, the limbs with PAA were classified as type IA, 133 (91.1%); type IB, 2 (1.4%); type IC, 0; type IIA1, 1 (0.7%); type IIA2, 1 (0.7%); type IIB, 4 (2.7%); type IIC, 0; type IIIA, 3 (2.1%); type IIIB, 0; and type IIIC, 2 (1.4%). In Group 2 the limbs with non-aneurysmal disease were classified as type IA, 163 (91.6%); type IB, 5 (2.8%); type IC, 1 (0.6%); type IIA1, 1 (0.6%); type IIA2, 3 (1.7%); type IIB, 2 (1.1%); type IIC, 0; type IIIA, 3 (1.7%); type IIIB, 0; and type IIIC, 0. No difference in terms of anatomy of the popliteal artery and its branches was found between the two groups ( P = NS). Conclusions Knowledge of anatomical variations of the popliteal artery and its branches is mandatory in case of the surgical approach. Anatomy in PAA patients is not different. Studies with larger population size are needed to validate these outcomes.

Published
2021

24. Secondary endovascular procedures improve overall patency and limb salvage in patients undergoing in situ saphenous vein infragenicular bypass

Author

Nicola, Troisi, Daniele, Adami, Stefano, Michelagnoli, Raffaella, Berchiolli, and Federico, Zani

Subjects
Settore MED/22, Surgery, General Medicine, Cardiology and Cardiovascular Medicine
Abstract

Secondary interventions strongly improves patency and limb salvage rates in patients undergoing infrainguinal vein bypass. The aim of this study was to evaluate the influence of secondary endovascular procedures performed during the follow-up on patency and limb salvage in patients with critical limb-threatening ischemia (CLTI) undergoing in situ saphenous vein infragenicular bypass.From January 2018 to December 2019 541 patients in 43 centers have been enrolled into the LIMBSAVE registry (treatment of critical Limb IschaeMia with infragenicular Bypass adopting in situ SAphenous VEin technique). In all patients a strict surveillance program with Duplex scan was established (1, 3, 6, 9, 12, 18, 24 months). During the follow-up indications for endovascular procedures were anastomotic stenoses, improvement of run-in (iliac stenosis) or run-off (tibial vessels' stenoses or occlusions). Two-year estimated outcomes in terms of overall patency, and limb salvage were analyzed by life-table analysis (Kaplan-Meier test). Outcomes obtained in patients undergoing endovascular procedure (Group-endo) were compared by means of Gehan-Breslow-Wilcoxon Test with those obtained in patients with no secondary endovascular procedure during the follow-up (Group-no endo).Two groups were homogeneous in terms of demographics and intraprocedural details. Overall mean duration of follow-up was 12.1 months (range 1-24). During the follow-up period (30 days) 55 endovascular procedures were performed in 49 patients (9.1%) (Group-endo). Most of endovascular procedures (37/55, 67.3%) was performed to treat stenoses at proximal or distal anastomosis. Secondary endovascular procedures (40/55, 72.7%) were predominantly performed within 6 months from the index procedure. Estimated 2-year overall patency (97.9% vs. 85.2%, P=0.05), and limb salvage (100% vs. 93.9%, P=0.05) rates were significantly better in Group-endo.Secondary endovascular procedures in patients with CLTI undergoing in situ saphenous infragenicular bypass significantly improve the rates of overall patency and limb salvage in the mid-term period.

Published
2022

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

Author

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

Subjects
general_medical_research
Abstract

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

Published
2022

26. Non-reversed bifurcated vein graft improves time to healing in ischemic patients undergoing lower limb distal bypass

Author

Nicola Troisi, Daniele Adami, Alberto Piaggesi, Francesco Canovaro, Letizia Pieruzzi, Lorenzo Torri, Mauro Ferrari, and Raffaella Berchiolli

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Bifurcated vein grafts have been described in reconstructive microsurgery. No comparative studies have been published in lower limb arterial revascularization. The aim of this study was to compare non-reversed bifurcated vs. single vein graft in patients with critical limb-threatening ischemia (CLTI) undergoing lower limb distal bypass.Between January 2015 and December 2021 193 CLTI patients have been treated at our center with vein bypass, and distal anastomosis on infrapopliteal vessels; 137 patients (71%) received a single graft (Group SIN), and 56 patients (29%) had a bifurcated bypass (Group BIF). Primary outcomes measures were time to healing, primary patency, primary assisted patency, secondary patency, and limb salvage. Two-year outcomes according to Kaplan-Meier curves were evaluated and compared.Both groups were homogeneous in terms of demographic data, preoperative risk factors, and clinical presentation except for an elderly age in Group BIF (77.5 vs. 71.5 years; P0.001). Intraoperative technical success was achieved in all patients. Overall median duration of follow-up was 19 months (interquartile range 9-36). Wound healing did not differ between the two groups (77.4% Group SIN vs. 73.2% Group BIF; P=0.33). Mean time to healing was faster in Group BIF (2.4 vs. 6.8 months; P0.001). At 2-year follow-up there were no differences between the two groups in terms of primary patency (71.4% Group SIN vs. 54% Group BIF; P=0.10), primary assisted patency (81.7% Group SIN vs. 76.4% Group BIF; P=0.53), secondary patency (85.1% Group SIN vs. 80.9% Group BIF; P=0.79), and limb salvage (92.3% Group SIN vs. 87.2% Group BIF; P=0.64).Bifurcated graft improved time to healing in CLTI patients undergoing infrapopliteal non-reversed vein bypass. Two-year overall patencies and limb salvage did not differ accordingly to vein graft configuration (single vs. bifurcated).

Published
2022

27. International Union of Angiology Position Statement on no-option chronic limb threatening ischemia

Author

Nicola TROISI, Mario D’ORIA, José FERNANDES E FERNANDES, Nikos ANGELIDES, Efthymios AVGERINOS, Christos LIAPIS, Emad HUSSEIN, Indrani SEN, Peter GLOVICZKI, Pavel POREDOS, Sandeep PANDEY, Federico BISCETTI, Michal JUSZYNSKI, Petar ZLATANOVIC, Roberto FERRARESI, Alberto PIAGGESI, Javier PEINADO CEBRIAN, Armando MANSILHA, and Pier L. ANTIGNANI

Subjects
Chronic Limb-Threatening Ischemia, Adolescent, Cardiology, Limb Salvage, Amputation, Surgical, Peripheral Arterial Disease, Treatment Outcome, Ischemia, Risk Factors, Chronic Disease, Quality of Life, Humans, Cardiology and Cardiovascular Medicine, Retrospective Studies
Abstract

This position paper, written by members of International Union of Angiology (IUA) Youth Committee and senior experts, shows an overview of therapeutical approaches for patients with chronic limb-threatening ischemia (CLTI) and absence of 'standard' solutions for revascularization. The aim was to demonstrate the accurate management of the 'no-option' CLTI patient including the wound treatment and the rehabilitation, considering always the goal of the increase of quality of life of the patients.

Published
2022

28. International Union of Angiology Position Statement on perioperative drug and hemostasis management in vascular surgery

Author

Nicola TROISI, Domenico BACCELLIERI, Federico BISCETTI, Mario D’ORIA, Omar ESPONDA, Rocio LAINEZ RUBE, Nora LECUONA, Mar OLLER GRAU, Javier PEINADO CEBRIAN, Sandeep R. PANDEY, Petar ZLATANOVIC, Jawed FAREED, and Pier L. ANTIGNANI

Subjects
Hemostasis, Adolescent, Cardiology, Humans, Cardiology and Cardiovascular Medicine, Vascular Surgical Procedures, Hemostatics
Abstract

This position paper, written by members of International Union of Angiology (IUA) Youth Committee, shows an overview of coagulation system and laboratory tests, analysis of medical therapies (older and newer), medication discontinuation/restart recommendations, bridging therapy recommendations, and an overview of hemostatic agents used in the operating room.

Published
2022

29. Reallocation of Carotid Surgery Activity with the Support of Telemedicine in a COVID-Free Clinic during COVID-19 Pandemic

Author

D. Battista, Aldo Alberti, Consuelo Cardinali, Nicola Troisi, Massimo Cincotta, Luciana Tramacere, Stefano Michelagnoli, and Emiliano Chisci

Subjects
Telemedicine, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Free clinic, business.industry, medicine.medical_treatment, COVID-19, Carotid endarterectomy, medicine.disease, Asymptomatic, Carotid surgery, film.subject, Stenosis, Clinical Neurology: Brief Report, Neurology, film, Pandemic, Emergency medicine, medicine, Neurology (clinical), medicine.symptom, business
Abstract

The aim of this study is to report the reallocation of carotid surgery activity with the support of telemedicine in a COVID-free clinic during COVID-19 pandemic. Patients with symptomatic carotid stenosis or asymptomatic vulnerable plaques were reallocated to a COVID-free private clinic which began to cooperate with the National Health System during the emergency. Quick training of staff nurses was performed. Surgeons moved to the COVID-19 free clinic. Remote cerebral monitoring was performed with the support of telemedicine. Twenty-four patients underwent standard carotid endarterectomy with eversion technique. Five patients (20.8%) had recently symptomatic stenosis, and the remaining 19 patients (79.2%) had a risky asymptomatic carotid stenosis. No technical issue with remote cerebral monitoring was detected. In the early postoperative period, no neurological/systemic complication was observed. Three patients under dual antiplatelet therapy (12.5%) had neck hematoma. All patients were discharged the day after surgery. In our preliminary experience, reallocation in a COVID-free clinic allowed us to maintain a functioning carotid surgery activity during COVID-19 pandemic. A multidisciplinary approach and support of telemedicine were crucial. Training of unskilled nurse staff was necessary.

Published
2021

30. Preliminary results from an Italian National Registry on the outcomes of the Najuta fenestrated aortic arch endograft

Author

Giacomo Isernia, Gioele Simonte, Matteo Orrico, Roberto Silingardi, Andrea Gaggiano, Tea Covic, Michelangelo Ferri, Massimo Lenti, Nicola Mangialardi, Gianbattista Parlani, Gianluigi Fino, Luigi Baccani, Paolo Leonardi, Stefano Gennai, Emanuele Ferrero, Simone Quaglino, Antonio Rizza, Gabriele Maritati, Michele Portoghese, Fabio Verzini, Raffaele Pulli, Aaron Fargion, Stefano Bonvini, Francesco Intrieri, Francesco Speziale, Wassim Mansour, Diego Moniaci, Raffaella Berchiolli, Nicola Troisi, Andrea Colli, Stefano Camparini, Giovanni Pratesi, Francesco Massi, Stefano Michelagnoli, Emanuele Chisci, Stefano Bonardelli, Massimo Maione, and Domenico Angiletta

Subjects
Surgery, Cardiology and Cardiovascular Medicine
Abstract

Arch pathology represents one of the last frontiers in aortic aneurysms endovascular management. Several companies recently developed dedicated branched and fenestrated endografts specifically designed for the aortic arch, aiming to overcome some of the issues associated with standard thoracic endograft and supra-aortic vessels extra-anatomical debranching. This study aimed to evaluate early outcomes obtained with a custom-made fenestrated endograft approved for thoracic aortic aneurysms exclusion.All consecutive patients treated with the Najuta endograft (Kawasumi Laboratories, Inc, Tokyo, Japan) in Italy were prospectively enrolled and included in the study population. Anatomical characteristics and perioperative data were retrospectively analyzed. Study endpoints were technical success, 30-day clinical success, overall survival, supra-aortic vessel patency, endoleak and need for reintervention or surgical conversion.During the period 2018-2022, seventy-six patients received a Najuta endograft in Italy and were enrolled in the study. Median age was 72 (IQR 69-76) years and 80.3% were male. Most of the patients received treatment for atherosclerotic aneurysms (80.3%) while the others for post-dissection aneurysms (7.9%), penetrating aortic ulcer (9.2%), or type I endoleak correction after previous thoracic endovascular repair (2.6%). Overall, 161 supra-aortic vessels were preserved through a dedicated fenestration. Technical success was achieved in 74/76 (97.4%) of procedures; both failures were associated with endoleak detection at final angiography (one type I and one type III endoleak). Two distal migrations occurred during the implanting procedure. Clinical success at 30 days was 94.7%. Two early reinterventions were needed within 30 days after index procedure: in one case an aortic false lumen coils embolization was performed, since distal re-entry caused enlargement of the post dissection thoracic aneurysm. The other procedure consisted of a femoral pseudoaneurysm repair. Median follow-up was 7 (IQR 3-15) months; no supra-aortic vessel occlusions occurred and no patients needed surgical conversion.Early results suggest that in selected patients with aortic arch pathology needing a proximal landing, an endovascular approach with the Najuta system is safe and effective, especially for those at high surgical risk. A strict follow-up with high-quality computed tomography angiography images and eventual long-term complications evaluation is needed to confirm these initial experience findings.

Published
2022

31. Occult endoleaks revealed during open conversions after endovascular aortic aneurysm repair in a multicenter experience

Author

Paolo, Perini, Mauro, Gargiulo, Roberto, Silingardi, Stefano, Bonardelli, Raffaello, Bellosta, Marco, Franchin, Stefano, Michelagnoli, Mauro, Ferrari, Giorgio U, Turicchia, Antonio, Freyrie, and Nicola, Troisi

Subjects
Cardiology and Cardiovascular Medicine
Abstract

An occult endoleak (OE) may be the underlying cause of aneurysm sac expansion after EVAR. The aim of this study is to describe intraoperative findings of OE during surgical endograft explantations.This is a retrospective, multicentre analysis of all open conversions (OC) after EVAR from 1997 to 2020 in 12 vascular centres. We excluded patients with a preoperative diagnosis of endograft infection, endograft thrombosis, and thoracic-EVAR. An OE was defined as an endoleak revealed during OC not shown on preoperative imaging, which was likely the real cause for sac enlargement. We reported the number of OE, and we described the type of OE in relation to the initial alleged or associated endoleak. A separate analysis of patients with an initial diagnosis of endotension was also performed.An OE was found in 32/255 patients (12.5%). In the 78.1% of the cases (25/32) a type II endoleak hid a type I or III endoleak. Endotension was the initial diagnosis of 26/255 patients (10.2%). In 4/26 cases (15.4%), a type I or II OE was revealed. In 5/26 cases (19.2%) an endograft infection was found intraoperatively. In 2/26 cases we found an angiosarcoma. Fifteen cases of endotension (57.7%) remained unexplained.OE represent a not negligible cause of EVAR failure. A type II endoleak associated with sac enlargement may actually conceal a higher-flow endoleak. In most of the cases, the initial diagnosis of endotension remains unexplained. However, endotension sometimes conceals severe underlying pathologies such as infections.

Published
2022

36. Sex Differences in Endovascular Treatment of Isolated Popliteal Lesions

Author

Denise M. D. Özdemir-van Brunschot, Giovanni B. Torsello, Sarah Litterscheid, Raffaella Berchiolli, Nicola Troisi, and Giovanni Federico Torsello

Subjects
Male, Sex Characteristics, Femoral Artery, Peripheral Arterial Disease, Treatment Outcome, Risk Factors, Humans, Radiology, Nuclear Medicine and imaging, Female, Popliteal Artery, Stents, Cardiology and Cardiovascular Medicine, Vascular Patency, Retrospective Studies
Abstract

Sex-based differences in peripheral arterial disease are well-known. Aim of this study was to evaluate sex-related disparities in patients undergoing endovascular treatment of isolated popliteal artery lesions.Between 1th January 2004 and 1th January 2021 304 patients underwent endovascular treatment of an isolated popliteal artery lesion at three vascular centers. A retrospective analysis was performed comparing the outcomes in female versus male patients.The majority of the patients were female (51.3%). Male patients were younger (70.4 vs. 76.8 years, p 0.01). Hyperlipidemia (62.2% vs. 45.5%, p 0.01) and diabetes (62% vs. 40%, p 0.01) were more common in male group. There were more current and former smokers in the male group (p = 0.04 and p = 0.01). There were no differences regarding lesion length (mean 94.5 mm) nor location of the lesion. Technical success was comparable in both groups 94.6% vs. 97.4%), no differences in terms of in-hospital complications (9.5% vs. 7.7%) were found. At 3 years estimates did not demonstrate any difference in terms of clinically driven target lesion revascularization (23% vs. 34%), secondary patency (86% vs. 96%), and all-cause mortality (77% vs. 67%) between the two groups.In our experience the female sex showed clinical signs of popliteal artery lesion at higher age with less aggressive atherosclerotic risk factors. However, during the follow-up no sex-related significant differences were found in terms of morphological and clinical outcomes after endovascular revascularization.

Published
2022

37. Different endovascular modalities of treatment for isolated atherosclerotic popliteal artery lesions (EMO-POP) registry

Author

Nicola Troisi, Athanasios Saratzis, Emmanuel Katsogridakis, Konstantinos Stavroulakis, Raffaella Berchiolli, Hany Zayed, Giovanni Torsello, Denise Özdemir-van Brunschot, Teresa Martín González, Thomas Denisselle, Grigorios Korosoglou, Giacomo Isernia, Stefano Michelagnoli, Antonio Nicola Giordano, Konstantinos P. Daonas, Apostolos G. Pitoulias, Stavros Spiliopoulos, Massimiliano Martelli, Alberto Maria Settembrini, and Mario D’Oria

Subjects
Atherosclerosis, Femoral Artery, Peripheral Arterial Disease, Treatment Outcome, Coated Materials, Biocompatible, Humans, Popliteal Artery, Surgery, Registries, Cardiology and Cardiovascular Medicine, Angioplasty, Balloon, Vascular Patency, Aged, Retrospective Studies
Abstract

The mid-term results after treatment of isolated popliteal lesions have been limited. The aim of the present study was to report the mid-term outcomes after endovascular treatment of isolated atherosclerotic popliteal artery lesions.A multicenter (15 hospitals in five countries) retrospective cohort study was performed. Between June 2016 and June 2021, 651 consecutive patients who had been treated for isolated popliteal lesions using endovascular methods exclusively were included in the present study. Six techniques were identified, including plain balloon angioplasty (PTA; n = 286; 43.9%), drug-coated balloon angioplasty (n = 98; 15.1%), stenting with low-chronic outward force (COF) stents (n = 84; 12.9%), stenting with high-COF stents (n = 76; 11.7%), atherectomy alone (n = 17; 2.6%), and directional atherectomy with drug-coated balloons (n = 90; 13.8%). The primary outcomes measures were primary and secondary patency and freedom from clinically driven target lesion revascularization (F-CDTLR).The mean patient age was 74.5 years. Most of the patients (n = 409; 62.9%) had had chronic limb-threatening ischemia. Popliteal occlusion was found in 400 cases (61.4%). High-grade calcification was present in 36.7% of cases. Immediate technical success was 94.8%. The median follow-up was 26 months (range, 6-42 months). The actuarial rate for all patients at 26 months (per outcome measure) was as follows: primary patency, 73.9%; secondary patency, 88%; and F-CDTLR, 76.5%. When comparing PTA vs all other treatments in an adjusted regression analysis, the F-CDTLR was 75.2% for PTA vs 76.5% for all other treatment (hazard ratio, 1.06; 95% confidence interval, 0.75-1.48; P = .46, adjusted regression). The difference in secondary patency also was not statistically significant (85.7% for PTA vs 88%; P = .20). Adjusted Kaplan-Meier analysis revealed that the estimated primary patency was inferior for PTA in pairwise comparisons vs other treatments (P .001 vs atherectomy; P = .002 vs directional atherectomy with drug-coated balloons; and P = .002 vs low-COF stenting).The results from our study have shown that endovascular treatment of isolated popliteal lesions is safe and associated with acceptable patency and F-CDTLR in the mid-term.

Published
2023

38. Sex-Related Outcomes Following Drug Balloon Angioplasty in Patients from the BIOLUX P-III Registry: A Subgroup Analysis

Author

Ian Patrick, Barry, Reane, Macarulay, Marianne, Brodmann, Thomas, Zeller, Matej, Moscovic, Johannes, Dahm, Nicola, Troisi, Gunnar, Tepe, Jacqueline, Wong, and Bibombe Patrice, Mwipatayi

Subjects
Male, Paclitaxel, Cardiovascular Agents, Limb Salvage, Femoral Artery, Peripheral Arterial Disease, Treatment Outcome, Coated Materials, Biocompatible, Humans, Radiology, Nuclear Medicine and imaging, Female, Popliteal Artery, Prospective Studies, Registries, Cardiology and Cardiovascular Medicine, Angioplasty, Balloon, Vascular Patency
Abstract

Purpose To evaluate the use of drug-coated balloons in a real-world patient population with peripheral arterial disease and analyse the impact of sex on mid-term outcomes following their utilisation. Methods The BIOLUX P-III is a prospective, international, multi-centre, registry of patients with infra-inguinal lesions treated using the Passeo-18 Lux, a drug-coated balloon. Our study is a 24-month subgroup analysis of these patients; primary endpoints were freedom from major adverse events and clinically driven target lesion re-vascularisation within 12 months post-intervention. Results Of the 877 patients in the registry, 561 (64.0%) were male and 316 (36.0%) were female. Chronic limb threatening ischaemia (Rutherford class ≥ 4) occurred in 35.7% of males and 40.6% of females. Rates of freedom from major adverse events and clinically driven target lesion re-vascularisation at 12 months were 87.3% (95% confidence interval [CI] 84.2–89.9) and 90.4% (95% CI 86.5–93.3), and 92.3% (95% CI 89.9–94.1) and 92.9% (95% CI 89.7–95.1) in males and females, respectively. All-cause mortality at 24 months was 12.0% (95% CI 9.4–15.3) in males and 11.9% (95% CI 8.6–16.5) in females. The major target limb amputation rate at 24 months was 9.1% (95% CI 6.9–11.9) in males and 4.0% (95% CI 2.3–7.0) in females. Conclusion Treatment with the Passeo-18 Lux DCB demonstrated high efficacy and low complication rates. Despite the greater proportion of chronic limb threatening ischaemia observed in females, males were at a greater risk of ipsilateral major limb amputation and major adverse events following drug-coated balloon utilisation. Clinical Trial Registration NCT02276313. Level of Evidence Level 4.

Published
2022

40. List of contributors

Author

Yogesh Acharya, Daniele Adami, Giuseppe Alba, Angela Alfonsi, Domenico Angiletta, Michele Antonello, Cassra Arbabi, Efthymios Avgerinos, Ali Azizzadeh, Fabiane Barbosa, Don Baril, Domenico Benevento, Raffaella Berchiolli, Fabio Bertani, Daniele Bissacco, Francesca Boccafoschi, Stefano Bonvini, Pietro Brambillasca, Alberto Caggiati, Keith D. Calligaro, Juan Carlos Parodi, Francesco Casella, Nabil Chakfe, Emiliano Chisci, Elda Chiara Colacchio, Simone Cuozzo, Raffaello Dallatana, Lazar Davidovic, Gianmarco de Donato, Claudio Desantis, Matthew J. Dougherty, Callie E. Dowdy, Mauro Ferrari, Thomas L. Forbes, Antonio Freyrie, Alice Fuggirai, Giuseppe Galzerano, Giovanni Giannace, Michele Giubbolini, M. Walter Guerrieri, Jake F. Hemingway, Susanne Honig, Niamh Hynes, Karl A. Illig, Young-wook Kim, Tilo Koelbel, Igor Koncar, Salomé Kuntz, Anne Lejay, Kendall Likes, Giuseppe Maiolino, Krystal Maloni, Armando Mansilha, Wassim Mansour, Davide Marinazzo, Claudio Bianchini Massoni, Francesca Miceli, Stefano Michelagnoli, Daniel Miles, Francesco Morelli, Bilal Nabulsi, Gustavo S. Oderich, Giancarlo Palasciano, Claudia Panzano, Edoardo Pasqui, Paolo Perini, Alejandro Pizano, Carlo Filippo Porreca, Raffaele Pulli, Antonio Rampoldi, Marco Rossato, Umberto G. Rossi, Eike Sebastian Debus, Omar Selim, Carlo Setacci, Francesco Setacci, Alberto M. Settembrini, Fernanda Settembrini, Piergiorgio Settembrini, Ivone Silva, Pasqualino Sirignano, Marco Solcia, Francesco Speziale, Benjamin W. Starnes, Lucia Di Stefano, Sherif Sultan, Akiko Tanaka, Emanuel R. Tenorio, Nicola Troisi, Douglas A. Troutman, Alessandro Ucci, Kunal T. Vani, Vincenzo Vento, Giulia Vettor, Roberto Vettor, Paola Wiesel, and Sergio Zacà

Published
2022

42. An unusual cause of failure in Zenith Alpha Abdominal endograft

Author

Raffaella N. Berchiolli, Michele Marconi, Irene Bargellini, Giulia Bertagna, Daniele Adami, Davide M. Mocellin, Roberto Cioni, Mauro Ferrari, and Nicola Troisi

Subjects
Male, Reoperation, Ultrasonography, Doppler, Duplex, Endoleak, Computed Tomography Angiography, General Medicine, Endovascular treatment/therapy, Prosthesis Failure, Endovascular aneurysm repair, Abdominal aortic aneurysm, Device design, Humans, Stents, Aorta, Abdominal, Aged, Aortic Aneurysm, Abdominal
Abstract

Background Graft disruption is an unusual complication of the endovascular abdominal aortic aneurysm repair (EVAR). Case presentation A 71-year-old man underwent standard EVAR with Zenith Alpha Abdominal endograft. Follow-up examinations revealed an initial significant sac shrinkage. At 24 months, duplex ultrasound (DUS) scan and computed tomography showed increase of the sac diameter associated with complete disconnection of the suprarenal stent-graft from the main body without evidence of endoleak. A standard relining with a thoracic endograft was performed between the suprarenal stent and the main body of the previous graft. At 6 months DUS revealed sac shrinkage. Conclusions This report demonstrates an uncommon cause of endograft failure with suprarenal stent disconnection from main body and highlights the need for continuous follow-up in patients undergoing EVAR.

Published
2022

43. Editor's Choice - Covered vs. Bare Metal Stents in the Reconstruction of the Aortic Bifurcation: Early and Midterm Outcomes from the COBRA European Multicentre Registry

Author

Athanasios Saratzis, Angeliki Argyriou, Robert Davies, Theodosios Bisdas, Arindam Chaudhuri, Giovanni Torsello, Konstantinos Stavroulakis, Hany Zayed, Said Abisi, Raphael Coscas, Ramita Dey, Ansy Egun, Mauro Gargiulo, Phillippe Ghibu, Lorenzo Gibello, Bella Huasen, Pui Fong Lau, Martin Malina, Stefano Michelagnoli, Lorenzo Patrone, Maria Antonella Ruffino, Prakash Saha, Nicola Troisi, Sarah Vanderhaute, Isabelle Van Herzeele, Regis Renard, and Alessia Sonetto

Subjects
Aorto-iliac disease, Revascularisation, Endovascular, Chronic limb threatening ischaemia, Peripheral arterial disease, Surgery, Claudication, Cardiology and Cardiovascular Medicine
Abstract

To report outcomes following endovascular revascularisation for severe aorto-iliac occlusive disease (AIOD) using covered (CS) or bare metal (BMS) stent(s).This was a retrospective cohort study including patients who underwent treatment with CS or BMS for AIOD between November 2012 and March 2020 in 12 European centres. Outcome measures included death, freedom from target lesion revascularisation (TLR), major amputation, and major adverse cardiac and cerebrovascular events (MACCE).Overall, 252 patients (53% males; mean age 65 ± 10 years) were included (102 with a bare metal and 150 with a covered aortic stent); 122 (48%) presented with chronic limb threatening ischaemia (CLTI). Severe arterial calcification was noted in65% of patients, 70% presented with Trans-Atlantic Societies Consensus (TASC) D lesions, 32% and 46% had aortic or iliac chronic total occlusion (CTO), respectively. Median follow up was 17 months (range 6 - 40; none lost to follow up). Median inpatient stay was two days (range two to four). During the first 30 days, two patients died (both with covered aortic stents, because of cardiovascular events), none required TLR, two (1%) patients had a major amputation (all presented with CLTI), and three (1%) had a MACCE. At 17 months, mortality (BMS 14% vs. CS 7%, hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.42 - 2.26, p = .94, log rank test) and TLR (11% vs. 10%, HR 1.98, 95% CI 0.89 - 4.43, p = .095) did not differ statistically significantly between the two groups; only three patients had a major limb amputation during late follow up (all with a covered stent). In a multivariable model, the use of an aortic CS did not influence TLR. In a conditional Cox regression, however, the concomitant use of aortic and iliac CSs was associated with improved freedom from TLR.Endovascular reconstruction with aortic CSs or BMSs for severe AIOD showed comparable midterm performance. The use of both aortic and iliac CSs seems to be associated with reduced TLR.

Published
2022

45. Open vascular surgery training in the endovascular era: 5-year experience with cadaver laboratory

Author

Luca GARRIBOLI, Emiliano CHISCI, Michele ANTONELLO, Gianbattista PARLANI, Efrem CIVILINI, Gabriele MARITATI, and Nicola TROISI

Subjects
Adult, Education, Medical, Graduate, Cadaver, Humans, Internship and Residency, Clinical Competence, Curriculum, Cardiology and Cardiovascular Medicine, Vascular Surgical Procedures
Abstract

Vascular cadaver laboratory (CAD LAB) courses included vascular exposure techniques and simulations of open procedures. Aim of the study was to demonstrate the benefit of cadaver laboratory (CAD LAB) courses to improve trainees' experience in open surgical vascular procedures.Between 2014 and 2020, 162 vascular surgeons or medical trainees (mean age 28 years) participated in vascular CAD LAB courses in Italy and France. Outcomes were measured using the Linkert survey, performed pre- and postcourse to evaluate self-efficacy/confidence, surgical experience, and resident perception of the course with a range score from 0 to 5 for each point. Anatomical knowledge improvement was measured using a questionnaire with multiple answers pre- and postcourse. The course was considered to have yielded a positive result if the postcourse Linkert Survey Score increased by ≥2 points, or in the case of an increase of at least 30% above the baseline value of the multiple questionnaires.Postcourse questionnaires were positive for all outcomes evaluated. Participants' perception of the usefulness of the CAD LAB evaluation was 4.8 out of 5. For the vascular CAD LAB, participant anatomical knowledge improved overall from an average of 55% to 93% (P0.001), and self-efficacy/confidence improved from 2.3 to 4.5 out of 5 (P0.001). Regarding the different operative procedures, the greatest self-efficacy/confidence improvement was recorded in carotid endarterectomy and aortic procedures (+50% and +66% respectively; P0.001). The city location (Italy vs. France) did not affect the results.CAD LAB courses were shown to be effective in increasing participants' self-efficacy, confidence, and anatomical knowledge in open vascular surgical procedures.

Published
2022

47. Factors Affecting Patency of In Situ Saphenous Vein Bypass: Two Year Results from LIMBSAVE (Treatment of critical Limb Ischaemia with infragenicular Bypass adopting in situ SAphenous VEin technique) Registry

Author

Nicola Troisi, Daniele Adami, Stefano Michelagnoli, Raffaella Berchiolli, Federico Accrocca, Alessio Amico, Andrea Angelini, Luca Arnuzzo, Andrea Ascoli Marchetti, Luca Attisani, Gennaro Bafile, Giuseppe Baldino, Enrico Barbanti, Stefano Bartoli, Raffaello Bellosta, Filippo Benedetto, Raoul Borioni, Franco Briolini, Cristina Busoni, Stefano Camparini, Pierluigi Cappiello, Luciano Carbonari, Francesco Casella, Giovanni Celoria, Andrea Chiama, Emiliano Chisci, Efrem Civilini, Francesco Codispoti, Barbara Conti, Giovanni Coppi, Giovanni De Blasis, Marcello D’Elia, Rossella Di Domenico, Carla Di Girolamo, Leonardo Ercolini, Alessandra Ferrari, Mauro Ferrari, Enzo Forliti, Paolo Frigatti, Dalmazio Frigerio, Pierfrancesco Frosini, Luca Garriboli, Antonio Nicola Giordano, Walter Guerrieri, Antonio Jannello, Mafalda Massara, Maurizio Merlo, Roberto Mezzetti, Tommaso Miccoli, Domenico Milite, Pietro Mingazzini, Marina Muncinelli, Giovanni Nano, Marco Natola, Claudio Novali, Giancarlo Palasciano, Reinhold Perkmann, Federica Persi, David Petruccelli, Mauro Pinelli, Giorgio Poletto, Carla Porta, Carlo Pratesi, Gianguido Pruner, Giovanni Ragazzi, Paolo Righini, Mauro Salvini, Paolo Scovazzi, Carlo Setacci, Alberto Maria Settembrini, Andrea Siani, Roberto Silingardi, Antonino Silvestro, Francesco Talarico, Valerio Tolva, Antonio Trani, Santi Trimarchi, Yamume Tshomba, Gennaro Vigliotti, Daniela Viola, Pietro Volpe, and Federico Zani

Subjects
Chronic Limb-Threatening Ischemia, Treatment Outcome, Ischemia, Risk Factors, Humans, Surgery, Saphenous Vein, Registries, Cardiology and Cardiovascular Medicine, Limb Salvage, Vascular Patency, Retrospective Studies
Abstract

The aim was to demonstrate contemporary outcomes of in situ saphenous vein bypass using a valvulotome.Analysis of two year outcomes of a multicentre registry based on the treatment of critical Limb Ischaemia with infragenicular Bypass adopting in situ SAphenous VEin technique (LIMBSAVE). Between January 2018 and December 2019, 541 patients in 43 centres were enrolled. In all patients an innovative valvulotome was used. Early outcomes were assessed. Two year outcomes according to Kaplan-Meier curves in terms of patency and limb salvage were evaluated. Associations between patient and procedure variables were analysed with univariable and multivariable analyses.In all cases, a valvulotome was able to lyse the valves. Vein injury due to the in situ technique was 3.5%. Thirty day mortality and major amputation rates were 3% and 0.9%, respectively. Mean follow up was 12.1 months. Two year estimated primary patency, primary assisted patency, secondary patency, and limb salvage were 69.1%, 81.4%, 86.5%, and 94.5%, respectively. Multivariable analysis showed an association between pre-operative vein diameter3 mm and lower primary patency (hazard ration [HR] 14.3, p.001), primary assisted patency (HR 9.4, p = .002), secondary patency (HR 7.2, p = .007), and limb salvage (HR 7.8, p = .005) rates. Distal anastomosis to a tibial or foot vessel was also associated with lower primary patency (HR 4.8, p = .033), and primary assisted patency (HR 6, p = .011) rates. Use of a suprafascial tributary collateral as a graft was associated with lower primary patency (HR 6.7, p = .013), and primary assisted patency (HR 4.2, p = .042) rates.Vein diameter3 mm, distal anastomosis on a tibial or foot vessel, and use of a suprafascial tributary collateral as a graft were significantly associated with loss of patency and limb loss during follow up.

Published
2021

48. Multicenter comparison between open conversions and semi-conversions for late endoleaks after endovascular aneurysm repair

Author

Paolo Perini, Mauro Gargiulo, Roberto Silingardi, Stefano Bonardelli, Raffaello Bellosta, Gabriele Piffaretti, Stefano Michelagnoli, Nicola Tusini, Patrizio Capelli, Giorgio Ubaldo Turicchia, Antonio Freyrie, Erica Mariani, GianLuca Faggioli, Enrico Gallitto, Mattia Migliari, Stefano Gennai, Barbara Paro, Paolo Baggi, Luca Attisani, Matteo Pegorer, Marco Tadiello, Marco Franchin, Stefano Bonvini, Emiliano Chisci, Nicola Troisi, Antonio Fontana, Francesco Strozzi, Matteo Scabini, Federico Mosso, Elisa Paciaroni, Salvatore Tarantini, Michele Leone, and Giancarlo Masi

Subjects
Reoperation, Open surgical conversion, Time Factors, Endoleak, EVAR explantation, Blood Vessel Prosthesis Implantation, Type I endoleak, Postoperative Complications, Risk Factors, Abdominal aortic aneurysm, Failed EVAR, Type II endoleak, Aged, Aged, 80 and over, Humans, Retrospective Studies, Treatment Outcome, Aortic Aneurysm, Abdominal, Endovascular Procedures, 80 and over, Abdominal, Aortic Aneurysm, Surgery, Cardiology and Cardiovascular Medicine
Abstract

The aim of this study is to compare early and follow-up outcomes of late open conversions (LOC, with complete or partial endograft explantation) and semi-conversions (SC, with endograft preservation) after endovascular aneurysm repair in a multicenter experience.All LOC and SC performed from 1997 to 2020 in 11 vascular centers were compared. Endograft infections or thrombosis were excluded. Primary endpoints were early mortality and long-term survival estimates. Secondary endpoints were differences in postoperative complication rates and conversion-related complications during follow-up.In the considered period, 347 patients underwent surgery for endovascular aneurysm repair complications. Among these, 270 were operated on for endoleaks (222 LOC, 48 SC). The two groups were homogeneous in terms of American Society of Anesthesiologists score (LOC, 3.2 ± 0.7; SC, 3 ± 0.5; P = .128) and main endograft characteristics (suprarenal fixation, bifurcated/aorto-uni-iliac configuration). The mean age was 75 ± 8 years for LOC and 79 ± 7 years for SC (P = .009). Reasons for LOC were: 62.2% (138/222) type I endoleak, 21.6% (48/222) type II endoleak, 7.7% (17/222) type III endoleak, and 8.5% (19/222) endotension. Indications for SC were: 64.6% (31/48) type II endoleak, 33.3% (16/48) type I endoleak, and 2.1% (1/48) type III endoleak. Thirty-day mortality was 12.2% (27/222) in the LOC group, and 10.4% (5/48) in the SC group (P = .73). Postoperative complication rate was higher in the LOC group (45.5% vs 29.2%; P = .04). The estimated survival rate after LOC was 80% at 1 year and 64% at 5 years; after SC, it was 72% at 1 year and 37% at 5 years (log-rank P = .01). During the median follow-up of 21.5 months (interquartile range, 2.4-61 months), an endoleak after SC was found in the 38.3% of the cases; sac growth was recorded in the 27.7% of SC patients.SC has an early benefit over LOC in terms of reduced postoperative complications but has a significantly inferior mid-term survival. The high rates of persistent and/or recurrent endoleaks reduce SC durability.

Published
2021

49. Benefits and Role of Carbon Dioxide Angiography in Case of Misalignment Between Fenestration and Target Vessel During Fenestrated Endovascular Aneurysm Repair

Author

Nicola Troisi, Stefano Michelagnoli, Filippo Turini, Fabrizio Masciello, Emiliano Chisci, and Simone Panci

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Endovascular Procedures, Target vessel, Carbon Dioxide, Prosthesis Design, Endovascular aneurysm repair, Aortography, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation, Treatment Outcome, Angiography, medicine, Humans, Radiology, Nuclear Medicine and imaging, Surgery, Stents, Radiology, Cardiology and Cardiovascular Medicine, Fenestration, business, Aortic Aneurysm, Abdominal, Retrospective Studies
Abstract

Purpose: To report the benefits and the role of carbon dioxide (CO2) angiography in case of misalignment between fenestration and target vessel during fenestrated endovascular aneurysm repair (F-EVAR). Technique: During F-EVAR, misalignment between fenestration and target vessel is a potentially catastrophic complication. In 2 patients, we experienced that one of the target vessels were not visible during standard angiography in different projections after positioning a fenestrated graft and even after cannulation of the corresponding fenestration. In both cases, the graft was sealed to the aortic wall but not in the predictable position. Consequently, acute occlusion of the target vessel was hypothesized. However, CO2 angiography was useful to evaluate patency of the target vessel clarifying the relative position of the fenestration versus the target vessel. Rescue maneuvers were feasible under the guidance of CO2 angiography in order to obtain the cannulation of both renal arteries. In both cases, the procedure was successfully accomplished. Conclusion: In case of misalignment of a fenestration during F-EVAR and non-visualization of the target vessel with standard angiography, CO2 angiography could have the unique and complementary role of clarifying the patency and position of the target vessel. In addition, CO2 could guide the rescue maneuvers.

Published
2021

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

Author

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

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

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

Published
2021

Catalog

Books, media, physical & digital resources
See catalog results