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1. Computational simulation of TEVAR in the ascending aorta for optimal endograft selection: A patient-specific case study.

Author: Rodrigo Romarowski, Michele Conti, Simone Morganti, Viviana Grassi, Massimiliano M. Marrocco-Trischitta, Santi Trimarchi, and Ferdinando Auricchio
Published: 2018
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2. Endovascular repair of descending thoracic aortic aneurysms—a mid-term report from the Global Registry for Endovascular Aortic Treatment (GREAT)

Author: Gabriele Piffaretti, Chiara Lomazzi, Gilbert R. Upchurch, Ali Azzizzadeh, Hector W.L. de Beaufort, Viviana Grassi, Santi Trimarchi, and Fred A. Weaver
Subjects: Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Time Factors, Adolescent, Thoracic, Thoracic endovascular aortic repair, Descending thoracic aneurysms, ®, Transient ischaemic attacks, Thoracic aortic aneurysm, Young Adult, Blood Vessel Prosthesis Implantation, Postoperative Complications, Risk Factors, Interquartile range, GORE, 80 and over, medicine, Humans, GREAT registry, Registries, Stroke, Aged, Retrospective Studies, Aged, 80 and over, Aortic Aneurysm, Thoracic, business.industry, Global Registry for Endovascular Aortic Treatment, Endovascular Procedures, General Medicine, Middle Aged, medicine.disease, Confidence interval, Blood Vessel Prosthesis, Female, Treatment Outcome, Aortic Aneurysm, Surgery, Cohort, Population study, Cardiology and Cardiovascular Medicine, Paraplegia, business
Abstract: OBJECTIVES The aim of this study was to evaluate the short- to mid-term outcomes of descending thoracic aortic aneurysm (DTAA) repair from the Gore Global Registry for Endovascular Aortic Treatment (GREAT). METHODS This is a multicentre sponsored prospective observational cohort registry. The study population comprised those treated for DTAA receiving GORE thoracic aortic devices for DTAA repair between August 2010 and October 2016. Major primary outcomes were early and late survival, freedom from aorta-related mortality and freedom from aorta-related reintervention. RESULTS There were 180 (58.1%) males and 130 (41.9%) females: the mean age was 70 ± 11 years (range 18–92). The median maximum DTAA diameter was 60 mm (interquartile range 54–68.8). Technical success was achieved in all patients. Operative mortality, as well as immediate conversion to open repair, was never observed. At the 30-day window, mortality occurred in 4 (1.3%) patients, neurological events occurred in 4 (1.3%) patients (transient ischaemic attacks/stroke n = 3, paraplegia n = 1) and the reintervention rate was 4.5% (n = 14). Estimated survival was 95.6% [95% confidence interval (CI) 92.6–97.4] at 6 months, 92.7% (95% CI 89.1–95.2) at 1 year and 57.3% (95% CI 48.5–65.1) at 5 years. Freedom from aorta-related mortality was 98.3% (95% CI 96.1–99.3) at 6 months, 98.3% (95% CI 96.1–99.3) at 1 year and 92.2% (95% CI 83.4–96.4) at 5 years. Freedom from thoracic endovascular aortic repair (TEVAR)-related reintervention at 5 years was 87.2% (95% CI 81.2–91.4). CONCLUSIONS TEVAR for DTAAs using GORE thoracic aortic devices is associated with a low rate of device-related reinterventions and is effective at preventing aorta-related mortality for up to 5 years of follow-up. Clinical registration number NCT number: NCT01658787. Subject collection 161, 164.
Published: 2021
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3. Regional Survey in Lombardy, Northern Italy, on Vascular Surgery Intervention Outcomes During The COVID-19 Pandemic

Author: Raffaello Bellosta, Gabriele Piffaretti, Stefano Bonardelli, Patrizio Castelli, Roberto Chiesa, Dalmazio Frigerio, Gaetano Lanza, Stefano Pirrelli, Giovanni Rossi, Santi Trimarchi, Franco Briolini, Pietro Cefali, Roberto Caronno, Aldo Arzini, Domenico Diaco, Vittorio Baratta, Stefano Aiello, Alessandro C.L. Molinari, Francesca Giovannini, Anna Maria Socrate, Matteo Ferraris, Antonino Silvestro, Gianluca Canu, Emidio Costantini, Davide Logaldo, Federico Romani, Alfredo Lista, Cristina Busoni, Marco Setti, Roberto Mezzetti, Piergiorgio Sala, Luca Bassi, Luca Luzzani, Matteo A. Pegorer, Luca Attisani, Claudio Carugati, Monica Vescovi, Piero Trabattoni, Stefano Zoli, Andrea Rignano, Clara Magri, Pierluigi Vandone, Sergio Losa, Efrem Civilini, Giovanni Nano, Daniela Mazzaccaro, Valerio Tolva, Jessica Lanza, Ruggiero Curci, Giovanna Simonetti, Chiara Lomazzi, Viviana Grassi, Daniele Bissacco, Andrea Kahlberg, Daniele Mascia, Raffaello Dallatana, Michele Carmo, Franco Ragni, Enrico M. Marone, Antonio Bozzani, Matteo Tozzi, Marco Franchin, Gianluca Lussardi, Vittorio Segramora, Gaetano Deleo, Matteo Crippa, Tiziano Porretta, Marco Viani, Silvia Stegher, Davide Foresti, Giovanni Bonalumi, Bellosta, R., Piffaretti, G., Bonardelli, S., Castelli, P., Chiesa, R., Frigerio, D., Lanza, G., Pirrelli, S., Rossi, G., Trimarchi, S., Briolini, F., Cefali, P., Caronno, R., Arzini, A., Diaco, D., Baratta, V., Aiello, S., Molinari, A. C. L., Giovannini, F., Socrate, A. M., Ferraris, M., Silvestro, A., Canu, G., Costantini, E., Logaldo, D., Romani, F., Lista, A., Busoni, C., Setti, M., Mezzetti, R., Sala, P., Bassi, L., Luzzani, L., Pegorer, M. A., Attisani, L., Carugati, C., Vescovi, M., Trabattoni, P., Zoli, S., Rignano, A., Magri, C., Vandone, P., Losa, S., Civilini, E., Nano, G., Mazzaccaro, D., Tolva, V., Lanza, J., Curci, R., Simonetti, G., Lomazzi, C., Grassi, V., Bissacco, D., Kahlberg, A., Mascia, D., Dallatana, R., Carmo, M., Ragni, F., Marone, E. M., Bozzani, A., Tozzi, M., Franchin, M., Lussardi, G., Segramora, V., Deleo, G., Crippa, M., Porretta, T., Viani, M., Stegher, S., Foresti, D., and Bonalumi, G.
Subjects: Male, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), COVID-19, acute limb ischaemia, vascular surgery activities, Cohort Studies, Postoperative Complications, Intervention (counseling), Pandemic, Humans, Medicine, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Outbreak, Middle Aged, Vascular surgery, Northern italy, Treatment Outcome, Italy, Health Care Surveys, Emergency medicine, Female, Surgery, Cardiology and Cardiovascular Medicine, business, Complication, Vascular Surgical Procedures, Cohort study
Abstract: Objective: The characteristics and outcomes of patients undergoing vascular surgery hospitalised and managed in Lombardy are described with a comparison of patients tested positive for COVID-19 (CV19-pos) vs. those tested negative (CV19-neg). Methods: This was a multicentre, retrospective, observational cohort study which involved all vascular surgery services in Lombardy, Northern Italy. Data were retrospectively merged into a combined dataset covering the nine weeks of the Italian COVID-19 pandemic phase 1 (8 March 2020 to 3 May 2020). The primary outcome was freedom from in hospital death, secondary outcomes were re-thrombosis rate after peripheral revascularisation, and freedom from post-operative complication. Results: Among 674 patients managed during the outbreak, 659 (97.8%) were included in the final analysis: 121 (18.4%) were CV19-pos. CV19-pos status was associated with a higher rate of complications (OR 4.5; p < .001, 95% CI 2.64 – 7.84), and a higher rate of re-thrombosis after peripheral arterial revascularisation (OR 2.2; p = .004, 95% CI 1.29 – 3.88). In hospital mortality was higher in CV19-pos patients (24.8% vs. 5.6%; OR 5.4, p < .001;95% CI 2.86 – 8.92). Binary logistic regression analysis identified CV19-pos status (OR 7.6; p < .001, 95% CI 3.75 – 15.28) and age > 80 years (OR 3.2; p = .001, 95% CI 1.61 – 6.57) to be predictors of in hospital death. Conclusion: In this experience of the vascular surgery group of Lombardy, COVID-19 infection was a marker of poor outcomes in terms of mortality and post-operative complications for patients undergoing vascular surgery treatments.
Published: 2021
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4. Risk factors for saphenous vein recanalization after endovenous radiofrequency ablation

Author: Meryl S. Logan, Viviana Grassi, Gabriele Piffaretti, Ruth L. Bush, Santi Trimarchi, Daniele Bissacco, and Chiara Lomazzi
Subjects: medicine.medical_specialty, Ablation Techniques, Radiofrequency ablation, medicine.medical_treatment, Preoperative risk, Risk Assessment, law.invention, Saphenous vein, Risk factors, Postoperative Complications, Risk Factors, law, medicine, Humans, Saphenous Vein, Clinical significance, In patient, Vein, Radiofrequency Ablation, business.industry, Endovascular Procedures, General Medicine, Venous Segment, Ablation, Treatment Outcome, medicine.anatomical_structure, Venous Insufficiency, Regional Blood Flow, Surgery, Radiology, Cardiology and Cardiovascular Medicine, business
Abstract: INTRODUCTION Target vein recanalization is defined as the postoperative detection of blood flow in a venous segment previously ablated. It can be occurred after thermal-tumescent procedures, as radiofrequency (RFA) and endovenous laser (EVLA) ablation techniques. Despite several papers described and analyzed incidence and consequences of recanalization, limited data are published on risk factors for this condition. The aim of this general review is to investigate clinical and instrumental risk factors for great and small saphenous veins recanalization after RFA, indicating their impact in the follow-up period. EVIDENCE ACQUISITION Articles were obtained through a detailed search of the scientific journal databases (PubMed, Scopus, Web of Science) for those published between January 1, 2011 to December 31, 2020. The term "radiofrequency venous ablation" was combined with "risk factors", "recanalization" and "recurrence", to obtain the first article cluster. EVIDENCE SYNTHESIS Risk factors analysis for saphenous vein recanalization after ablation is not a well-studied problem. Although several studies have analyzed recanalization patterns and anatomical causes of ablation failure, few and disaggregate data are available regarding clinical preoperative risk factors. BMI and saphenous trunk diameter seem to be the only two recognized characteristics that may affect short and long-term recanalization rate, though CVI status, sex, target vein treatment length and others factors may be taken into account. CONCLUSIONS Physicians should consider risk factors for recanalization in patient selection and treatment recommendations, but also recognize that not all "ablation failures" are of clinical relevance.
Published: 2021
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5. Differences in hub and spoke vascular units practice during the novel Coronavirus-19 (COVID-19) outbreak in Lombardy, Italy

Author: Bellosta, Raffaello, Bissacco, Daniele, Rossi, Giovanni, Pirrelli, Stefano, Lanza, Gaetano, Frigerio, Dalmazio, Chiesa, Roberto, Castelli, Patrizio, Bonardelli, Stefano, Trimarchi, Santi, Stefano Aiello, Aldo Arzini, Luca Attisani, Vittorio Baratta, Luca Bassi, Giovanni Bonalumi, Antonio Bozzani, Franco Briolini, Cristina Busoni, Gianluca Canu, Michele Carmo, Roberto Caronno, Claudio Carugati, Pietro Cefali, Efrem Civilini, Emidio Costantini, Matteo Crippa, Ruggiero Curci, Raffaello Dallatana, Gaetano Deleo, Domenico Diaco, Matteo Ferraris, Davide Foresti, Marco Franchin, Francesca Giovannini, Viviana Grassi, Andrea Kahlberg, Jessica Lanza, Davide Logaldo, Chiara Lomazzi, Sergio Losa, Alfredo Lista, Gianluca Lussardi, Luca Luzzani, Clara Magri, Enrico M Marone, Daniele Mascia, Daniela Mazzaccaro, Roberto Mezzetti, Alessandro C Molinari, Giovanni Nano, Matteo A Pegorer, Gabriele Piffaretti, Tiziano Porretta, Franco Ragni, Andrea Rignano, Federico Romani, Piergiorgio Sala, Vittorio Segramora, Marco Setti, Antonino Silvestro, Giovanna Simonetti, Anna M Socrate, Silvia Stegher, Valerio Tolva, Matteo Tozzi, Piero Trabattoni, Pierluigi Vandone, Monica Vescovi, Marco Viani, Stefano Zoli, Bellosta, Raffaello, Bissacco, Daniele, Rossi, Giovanni, Pirrelli, Stefano, Lanza, Gaetano, Frigerio, Dalmazio, Chiesa, Roberto, Castelli, Patrizio, Bonardelli, Stefano, Trimarchi, Santi, Stefano, Aiello, Aldo, Arzini, Luca, Attisani, Vittorio, Baratta, Luca, Bassi, Giovanni, Bonalumi, Antonio, Bozzani, Franco, Briolini, Cristina, Busoni, Gianluca, Canu, Michele, Carmo, Roberto, Caronno, Claudio, Carugati, Pietro, Cefali, Efrem, Civilini, Emidio, Costantini, Matteo, Crippa, Ruggiero, Curci, Raffaello, Dallatana, Gaetano, Deleo, Domenico, Diaco, Matteo, Ferrari, Davide, Foresti, Marco, Franchin, Francesca, Giovannini, Viviana, Grassi, Kahlberg, ANDREA LUITZ, Jessica, Lanza, Davide, Logaldo, Chiara, Lomazzi, Sergio, Losa, Alfredo, Lista, Gianluca, Lussardi, Luca, Luzzani, Clara, Magri, Enrico, M Marone, Daniele, Mascia, Daniela, Mazzaccaro, Roberto, Mezzetti, Alessandro, C Molinari, Giovanni, Nano, Matteo, A Pegorer, Gabriele, Piffaretti, Tiziano, Porretta, Franco, Ragni, Andrea, Rignano, Federico, Romani, Piergiorgio, Sala, Vittorio, Segramora, Marco, Setti, Antonino, Silvestro, Giovanna, Simonetti, Anna, M Socrate, Silvia, Stegher, Valerio, Tolva, Matteo, Tozzi, Piero, Trabattoni, Pierluigi, Vandone, Monica, Vescovi, Marco, Viani, and Stefano, Zoli
Subjects: Adult, Male, medicine.medical_specialty, Multivariate analysis, medicine.medical_treatment, Pneumonia, Viral, COVID-19, Vascular surgical procedures, Multicenter registry, Emergencies, Disease, Vascular surgery, Vascular emergencies, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Clinical endpoint, Humans, Registries, Vascular Diseases, Pandemics, Referral and Consultation, Aged, Retrospective Studies, business.industry, Vascular disease, SARS-CoV-2, Mortality rate, General Medicine, Middle Aged, medicine.disease, Hospitalization, Pneumonia, 030228 respiratory system, Amputation, Italy, Surgery, Female, Cardiology and Cardiovascular Medicine, business
Abstract: BACKGROUND: To highlight clinical practice among referral (Hub, HH) or satellite (Spoke, SH) hospitals Vascular Surgery Units (VSUs) in Lombardy, during the COVID-19 pandemic "phase 1" period (March 8 - May 3, 2020). METHODS: The Vascular Surgery Group of Regione Lombardia Register, a real-word, multicenter, retrospective register was interrogated. All patients admitted with vascular disease were included. Patients' data on demographics, COVID-19 positivity, comorbidities and outcomes were extrapolated. Two cohorts were obtained: patients admitted to HH or SH. Primary endpoint was 30- day mortality rate. Secondary outcomes were 30-day complications and amputation (in case of peripheral artery disease [PAD]) rates. Univariate and multivariate analysis were used to compare HH and SH groups and predictors of poor outcomes. RESULTS: During the study period, 659 vascular patients in 4 HH and 27 SH were analyzed. Among these, 321 (48.7%) were admitted to a HH. No difference in COVID-19 positive patients was described (21.7% in HH vs 15.9% in SH; p=.058). After 30 days from intervention, HH and SH experienced similar mortality and no-intervention-related complication rate (12.1% vs 10.0%; p=.427 and 10.3% vs 8.3%; p=.377, respectively). Conversely, in HH postoperative complications were higher (23.4% vs 16.9%, p=.038) and amputations in patients treated for PAD were lower (10.8% vs 26.8%; p
Published: 2020

6. COVID-19 and supra-aortic trunks disease: review of literature about critical phase and sequelae

Author: Chiara Malloggi, Santi Trimarchi, Viviana Grassi, Silvia Romagnoli, Gianfranco Parati, Vincenzo Silani, Marc L. Schermerhorn, Daniele Bissacco, Maurizio Domanin, and Renato Casana
Subjects: Carotid Artery Diseases, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Disease, Risk Assessment, Critical phase, Risk Factors, Pandemic, medicine, Humans, Intensive care medicine, Ischemic Stroke, Mechanism (biology), business.industry, COVID-19, Thrombosis, General Medicine, medicine.disease, Stenosis, Treatment Outcome, Biomarker (medicine), Surgery, Cardiology and Cardiovascular Medicine, business, Vascular Surgical Procedures
Abstract: The acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the COVID-19 disease, a global pandemic. A strong association has been documented between COVID-19 and cardiovascular events, although the exact pathophysiological mechanism is still unclear. Carotid atherothrombosis and ischemic stroke represents one of the possible severe manifestations of COVID-19, as a leading cause of long-term disability and death. Different complex intertwined mechanisms seem to underlie the endothelitis which is the cause of multiple cardiovascular manifestations. To date, few case series describing COVID-19 and acute ischemic stroke caused by cervical carotid thrombosis have been published. All the patients shared common similar radiographic features, comorbidities, and biomarker profiles. The aim of this brief review was to analyze the impact of COVID-19 pandemic in the management of a Vascular Surgery Department, changing the daily vascular practice, as well as to provide practical suggestions for symptomatic carotid stenosis, while reviewing published literature.
Published: 2021

7. 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 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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

8. Pre-surgical embolization of carotid body paragangliomas: advantages of direct percutaneous approach and transitory balloon-occlusion at the origin of the external carotid artery

Author: Aldo Paolucci, Anna Maria Ierardi, Sophia Hohenstatt, Viviana Grassi, Silvia Romagnoli, Lorenzo Pignataro, Santi Trimarchi, and Gianpaolo Carrafiello
Subjects: Treatment Outcome, Carotid Artery, External, Humans, Radiology, Nuclear Medicine and imaging, General Medicine, Balloon Occlusion, Carotid Body Tumor, Embolization, Therapeutic, Retrospective Studies
Abstract: Different embolization techniques and materials are available for the pre-operative embolization of carotid body paragangliomas. In this study, we report the first experience of the direct percutaneous puncture technique under fluoroscopic guidance using the low-viscosity formula of SQUID-12. The additional use of a transitory balloon-blockage at the origin of the external carotid artery aims to confer higher protection by limiting the risk of non-target embolization and subsequent neurological sequelae.We retrospectively reviewed all cases of carotid body paragangliomas that have undergone pre-surgical embolization with a direct puncture technique and balloon-assistance at our institution between 2019 and 2020. The use of the liquid EVOH-based SQUID-12 as the sole embolic agent was the main inclusion criteria.A total of 9 patients with 9 carotid body paragangliomas were enrolled in this case series. The mean volume of the lesion was 309 mm3. The mean embolization-session time amounted to 88 min. The average number of needles inserted was 2, and the mean volume of SQUID-12 used per case was 23 ml. Successful total devascularization was obtained in all cases. No long-term sequelae due to the embolization procedure occurred.Pre-operative paraganglioma embolization with SQUID-12 using a direct puncture and balloon-assisted technique is a safe and efficient method with few complications.
Published: 2021

9. Reply

Author: Maria Katsarou, Viviana Grassi, Chiara Lomazzi, Maurizio Domanin, and Santi Trimarchi
Subjects: SARS-CoV-2, COVID-19, Humans, Surgery, Cardiology and Cardiovascular Medicine, Letter to the Editor
Published: 2021
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10. Is there a vascular side of the story? Vascular consequences during COVID-19 outbreak in Lombardy, Italy

Author: Raffaello Bellosta, Gabriele Piffaretti, Maurizio Domanin, Daniele Bissacco, Santi Trimarchi, Chiara Lomazzi, and Viviana Grassi
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Activities of daily living, Referral, Population, Disease, 030204 cardiovascular system & hematology, vascular surgery, A Review Article, 03 medical and health sciences, 0302 clinical medicine, COVID‐19, Pandemic, medicine, COVID-19, acute limb ischemia, aorta and great vessels, vascular emergencies, Humans, education, Pandemics, Review Articles, education.field_of_study, SARS-CoV-2, business.industry, Outbreak, Vascular surgery, medicine.disease, Venous thrombosis, Italy, 030228 respiratory system, Emergency medicine, Surgery, business, Cardiology and Cardiovascular Medicine, Vascular Surgical Procedures
Abstract: Background Lombardy, in the northern Italy, was one of the most affected region in the world by novel coronavirus COVID‐19 outbreak. Due to the dramatic amount of confirmed positive cases and deaths, all clinical and surgical hospital departments changed their daily activities to face emergent pandemic situations. In particular, vascular surgery units reorganized their role and priorities for both elective and urgent patients requiring open or endovascular interventions. Material & Methods This brief review summarizes organization of vascular Lombardy centers network adopted during pandemic period and clinical evidences published so far by regional referral and nonreferral hospitals in terms of vascular surgery and medicine implications in COVID‐19 positive or negative patients managements. Results Different patterns of disease were described during phase 1 COVID‐19 outbreak in Lombardy region, with major attention in pheriperal artery disease and venous thrombosis. Conclusion COVID‐19 infection seems to be not only a pulmonary but also a vascular (arterial and venous) disease. Further study are necessary to described mid and long‐term outcomes in COVID‐19 vascular patients population.
Published: 2021

11. Endovascular type A aortic repair-When?

Author: Daniele Bissacco, Maurizio Domanin, Gabriele Piffaretti, Santi Trimarchi, Viviana Grassi, Chiara Lomazzi, and Raffaello Bellosta
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Aortic Aneurysm, Thoracic, business.industry, Treatment outcome, Endovascular Procedures, medicine.disease, Aortic repair, Surgery, Blood Vessel Prosthesis, Aortic aneurysm, Aortic Dissection, Blood Vessel Prosthesis Implantation, Text mining, Aneurysm, Treatment Outcome, Blood vessel prosthesis, Cardiothoracic surgery, Medicine, Humans, Cardiology and Cardiovascular Medicine, business
Published: 2020

12. Endovascular repair of ascending aortic diseases with custom-made endografts

Author: Santi Trimarchi, Gino Gerosa, Thomas Wolfgruber, Sebastian Fernandez-Alonso, C Probst, Martin Czerny, Peter Matt, Mohamad Hamady, Gabriele Piffaretti, Michele Antonello, Chiara Lomazzi, Sandro Ferrarese, Roman Gottardi, Viviana Grassi, Federico Fontana, and Vicente Riambau
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Custom-made endograft, Fistula, Aortic Diseases, Aorta, Thoracic, 030204 cardiovascular system & hematology, Ascending pseudoaneurysm, Blood Vessel Prosthesis Implantation, 03 medical and health sciences, Pseudoaneurysm, Postoperative Complications, 0302 clinical medicine, Interquartile range, medicine.artery, Ascending aorta, medicine, Humans, Lost to follow-up, Retrospective Studies, Aorta, Ascending TEVAR, business.industry, Endovascular Procedures, Retrospective cohort study, General Medicine, medicine.disease, Blood Vessel Prosthesis, Surgery, Dissection, Treatment Outcome, 030228 respiratory system, Stents, Cardiology and Cardiovascular Medicine, business
Abstract: OBJECTIVES The aim of this article is to report the mid-term results of ascending thoracic endovascular aortic repair using a custom-made device (CMD). METHODS This was a retrospective study performed at tertiary centres. Nine patients considered unfit for open surgery received elective total endovascular repair of the ascending aorta with a Relay® (Terumo Aortic, Sunrise; FL, USA) CMD: pseudoaneurysn (n = 5), localized dissection (n =3) and contained rupture (n = 1). RESULTS Primary clinical success was achieved in all patients with no major complications and no early conversion to open surgery. All patients were discharged home and independent: median length of stay was 7 days (interquartile range, 6–18). No patient was lost to follow-up at a median 26 months (interquartile range, 12–36). Three patients died 2, 6 and 24 months after intervention; 1 was aorta related (late aorto-atrial fistula due to infection that required open surgery). At the last follow-up available, no endoleaks, migrations, fractures or ruptures were observed in the remaining 6 patients. CONCLUSIONS Ascending thoracic endovascular aortic repair with Terumo Aortic CMDs was technically feasible, effective and safe in very selected lesions. CMDs showed good ascending aorta conformability with different configurations and diameters, and satisfactory mid-term durability as shown by both structural integrity and aortic lesion exclusion.
Published: 2020

13. Pre-operative Color Doppler Ultrasonography Predicts Endovenous Heat Induced Thrombosis after Endovenous Radiofrequency Ablation

Author: Chiara Lomazzi, Marta Cova, Viviana Grassi, Daniele Bissacco, Santi Trimarchi, Sara Segreti, and Ruth L. Bush
Subjects: Adult, Male, medicine.medical_specialty, Hot Temperature, Time Factors, Databases, Factual, Radiofrequency ablation, 030204 cardiovascular system & hematology, law.invention, 03 medical and health sciences, Small saphenous vein, 0302 clinical medicine, Predictive Value of Tests, Risk Factors, law, Odds Ratio, medicine, Humans, Saphenous Vein, 030212 general & internal medicine, Ultrasonography, Doppler, Color, Vein, Superficial epigastric vein, Retrospective Studies, Venous Thrombosis, Chi-Square Distribution, business.industry, Endovascular Procedures, Great saphenous vein, Anticoagulants, Heparin, Low-Molecular-Weight, Middle Aged, medicine.disease, Thrombosis, Surgery, Pulmonary embolism, Venous thrombosis, Logistic Models, Treatment Outcome, medicine.anatomical_structure, Italy, Venous Insufficiency, Multivariate Analysis, Catheter Ablation, Female, Pulmonary Embolism, Cardiology and Cardiovascular Medicine, business
Abstract: The aim was to identify pre-operative color Doppler ultrasound (CDUS) variables predictive of post-operative endovenous heat induced thrombosis (EHIT) after radiofrequency ablation (RFA) of the saphenous veins.This was a single centre, observational study with retrospective analysis of consecutive patients treated from December 2010 to February 2017.Pre-operatively, the diameter of the sapheno-femoral junction (dSFJ), distance between superficial epigastric vein and SFJ (dSEV-SFJ) [corrected], maximum great saphenous vein (GSV) diameter (mdGSV), diameter of the saphenous-popliteal junction (dSPJ), and mean small saphenous vein (SSV) diameter (adSSV) were measured. All patients received low molecular weight heparin (LWMH) at a prophylactic dose for a week. Post-operatively, CDUS was performed after 72 h, 1 week, and 3 months.Venous interventions on 512 patients were performed: 449 (87.7%) underwent RFA of the GSV (Group 1), and 63 (12.3%) of the SSV (Group 2). At Day 3 post-operatively, CDUS documented 100% complete closure of the treated saphenous vein segment. Overall, 40 (7.8%) cases of post-operative EHIT were identified: 29 in Group 1, and 11 in Group 2 (6.4% vs. 17.5%, p = .005). Deep venous thrombosis or pulmonary embolism did not occur in either group. At the 1 month follow up, all cases of EHIT regressed. In Group 1, on multivariate analysis, dSEV-SFJ [corrected] (OR, 1.13, p = .036; 95% CI 1.01-1.27) was the only statistically significant predictor for EHIT. A dSEV-SFJ [corrected] distance of 4.5 mm yielded an 84% of sensitivity for EHIT prediction with a 72.4% positive predictive value. In Group 2, univariate analysis did not identify independent risk factors for EHIT occurrence.EHIT was higher than previously reported. The dSEV-SFJ [corrected] was the most significant predictor for EHIT in the GSV group. A greater distance between the tip of the radiofrequency catheter and the SFJ may decrease the risk of developing this complication.
Published: 2018
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14. Acute retrograde type A intramural hematoma during severe acute respiratory syndrome coronavirus 2 pandemic

Author: Maurizio Domanin, Santi Trimarchi, Chiara Lomazzi, Viviana Grassi, and Maria Katsarou
Subjects: medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), business.industry, Intramural hematoma, Internal medicine, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Severity of illness, Pandemic, medicine, Surgery, Cardiology and Cardiovascular Medicine, business
Published: 2021
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15. Thoracic Endovascular Aortic Repair in 'Shaggy Thoracic Aortic Aneurysms'

Author: Chiara Lomazzi, Marco Franchin, Ruth L. Bush, Viviana Grassi, Matteo Tozzi, and Gabriele Piffaretti
Subjects: Male, medicine.medical_specialty, Time Factors, Computed Tomography Angiography, medicine.medical_treatment, Atheroembolization, Shaggy aorta, TEVAR, Aorta, Thoracic, Single Center, 030218 nuclear medicine & medical imaging, Cohort Studies, Blood Vessel Prosthesis Implantation, 03 medical and health sciences, 0302 clinical medicine, Aneurysm, Risk Factors, medicine.artery, medicine, Humans, Radiology, Nuclear Medicine and imaging, Hospital Mortality, Prospective Studies, Embolization, Thrombus, Aged, Retrospective Studies, Computed tomography angiography, Aged, 80 and over, Aorta, Aortic Aneurysm, Thoracic, medicine.diagnostic_test, business.industry, Endovascular Procedures, Acute kidney injury, Middle Aged, medicine.disease, Surgery, Treatment Outcome, Female, Cardiology and Cardiovascular Medicine, business, Magnetic Resonance Angiography, Follow-Up Studies, Cohort study
Abstract: To report the outcomes of thoracic endovascular aortic repair (TEVAR) for shaggy thoracic aortic aneurysms (STA). It is a single center, retrospective, observational, cohort study. Data were collected prospectively between January 2005 and May 2019. STA was defined, based on computed tomography angiography findings, as the presence of an irregular/ulcerated atheroma protruding and/or thrombus thickness ≥ 5 mm protruding into the aortic lumen, and/or occupying more than two thirds of the circumference of the aortic diameter axially. Primary outcomes were early (≤ 30 days) and late survival and freedom from major complication due to end-organ or peripheral ischemic embolization. Nine (2.3%) of 391 patients met the inclusion criteria. Mean age was 71 years ± 10 (range 55–83). Mean aneurysm diameter was 68 mm ± 0.5 (range 60–75). Four patients presented symptomatic: rupture (n = 2), blue toe syndrome (n = 2). TEVAR was performed in 7 of the 9 patients. Operative-related embolization occurred in 1 patient (transient ischemic attack and acute kidney injury). In-hospital mortality was observed in 1 patient following spinal cord ischemia and multiple organ failure development. Median follow-up was 48 months (IQR 5–84). Freedom from major complication due to end-organ or peripheral ischemic embolization was achieved in all patients. No patient developed further localization of STA in the proximal or distal aorta, and did not experience reno-visceral or peripheral atheroembolization episodes. Risk of atheroembolism in STA is still threatening but TEVAR proved to be an effective and durable treatment in this high-risk cohort.
Published: 2021
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16. Art of operative techniques: treatment options in arch penetrating aortic ulcer

Author: Gabriele Piffaretti, Carlo De Vincentiis, Maurizio Domanin, Santi Trimarchi, Viviana Grassi, and Chiara Lomazzi
Subjects: Aortic arch, medicine.medical_specialty, business.industry, Art of Operative Techniques, Hybrid aortic arch repair, Penetrating aortic ulcer (PAU), Surgical options, Thoracic endovascular aortic repair (TEVAR), Treatment options, Aortic repair, Surgery, Landing zone, medicine.artery, medicine, cardiovascular system, Arch, Cardiology and Cardiovascular Medicine, business
Abstract: Penetrating aortic ulcer (PAU) of the arch has a focal extent which often represents an adequate anatomic target for thoracic endovascular aortic repair (TEVAR). However, the anatomic constraints represented by the supra-aortic vessels pose either clinical or technical challenges that increase when the PAU develops proximally in the arch. Currently, different types of endografts are commercially available and have been used to treat aortic arch lesions. These include branched/fenestrated endografts for a total endovascular approach, and standard devices that can be used in combination with open/hybrid surgical operations, with the aim to exploit the minimally invasive nature of TEVAR by extending the proximal landing zone when necessary. We describe several current techniques adopted in such settings.
Published: 2019

17. Gender Related Access Complications After TEVAR: Analysis from the Retrospective Multicentre Cohort GORE® GREAT Registry Study

Author: Gabriele Piffaretti, Mark F. Fillinger, H.W.L. de Beaufort, Ross Milner, Eric L.G. Verhoeven, Viviana Grassi, Mauro Gargiulo, Piergiorgio Cao, Chiara Lomazzi, Santi Trimarchi, Chiara Mascoli, Fred A. Weaver, Lomazzi C., Mascoli C., de Beaufort H.W.L., Cao P., Weaver F., Milner R., Fillinger M., Verhoeven E., Grassi V., Gargiulo M., Trimarchi S., and Piffaretti G.
Subjects: Registrie, Male, Time Factors, Aorta, Thoracic, Sex Factor, 030204 cardiovascular system & hematology, 030230 surgery, Pseudoaneurysm, 0302 clinical medicine, Postoperative Complications, Retrospective Studie, Risk Factors, Stent, Registries, Aged, 80 and over, Incidence, Endovascular Procedures, Access complication, Middle Aged, Europe, Dissection, Blood Vessel Prosthesi, Treatment Outcome, Cohort, Female, Stents, Cardiology and Cardiovascular Medicine, Cohort study, Human, medicine.medical_specialty, Time Factor, Thoracic endovascular aortic repair, Prosthesis Design, Risk Assessment, 03 medical and health sciences, Blood Vessel Prosthesis Implantation, Sex Factors, Female gender, Blood vessel prosthesis, Catheterization, Peripheral, medicine, Humans, Sex Distribution, Aged, Retrospective Studies, Endovascular Procedure, business.industry, Risk Factor, Retrospective cohort study, medicine.disease, Surgery, Blood Vessel Prosthesis, Seroma, Introducer sheath, Postoperative Complication, business
Abstract: Objective The Global Registry for Endovascular Aortic Treatment (GREAT), a retrospective sponsored registry, was queried to determine the incidence and identify potential predictors of access related complications after TEVAR. Methods This is a multicentre, observational cohort study. For the current study, all patients were treated only with the Conformable GORE® TAG® Thoracic Endoprosthesis and GORE® TAG® Thoracic Endoprosthesis devices for any kind of thoracic aortic disease. All serious adverse events within 30 days of the procedure were documented by sites. The following were considered access related complications: surgical site infection, pseudoaneurysm, avulsion, dissection, arterial bleeding, access vessel thrombosis/occlusion, seroma, and lymphocoele. Results A total of 887 patients was analysed: most of the cases had an operative indication for TEVAR of degenerative atherosclerotic aneurysm (n = 414, 46.7%) and type B dissection (n = 270, 30.4% either complicated or uncomplicated). Two hundred and ninety-five patients (33.3%) were female. The overall access related complication rate was 2.8% (n = 25): 4.7% (n = 14) in women and 1.8% (n = 11) in men (p = .013). After adjustment for age, urgency, device diameter, introducer sheath (≥24Fr vs. ≤ 24Fr), access vessel diameters, and access method, female gender was significantly associated with the risk of access complications (OR 2.85; p = .038). Brachial artery for access was also found to be an independent predictor of access related complications (OR 8.32; p Conclusion This analysis suggests that women may have a higher access related complication rate after TEVAR, irrespective of the clinical setting, type of aortic disease, and device sizing.
Published: 2019

18. Computational tools for thoracic endovascular aortic repair planning

Author: Viviana Grassi, Santi Trimarchi, Hector W.L. de Beaufort, Rodrigo M. Romarowski, Ferdinando Auricchio, and Michele Conti
Subjects: medicine.medical_specialty, Aorta, business.industry, medicine.artery, Medicine, Surgery, Cardiology and Cardiovascular Medicine, business, Aortic repair
Published: 2019
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19. A rare case of paradoxical pulmonary embolism in spontaneous aortocaval fistula

Author: Andrea Bellobuono, Santi Trimarchi, S. Crespi, Anna Maria Ierardi, Gianpaolo Carrafiello, Viviana Grassi, Valentina Vespro, Maria Carmela Andrisani, Stefano Fusco, and Ilenia D'Alessio
Subjects: Abdominal pain, medicine.medical_specialty, Case Report, digestive system, Inferior vena cava, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Paradoxical embolism, Aortocaval fistula, Medicine, cardiovascular diseases, business.industry, General Medicine, Emergency department, medicine.disease, digestive system diseases, Abdominal aortic aneurysm, Pulmonary embolism, Surgery, medicine.vein, 030220 oncology & carcinogenesis, cardiovascular system, medicine.symptom, business, Complication
Abstract: Aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysm (AAA), occurring in less than 1% of all AAAs. Paradoxical embolism can rarely be associated with ACF, pulmonary embolism may originate from dislodgment of thrombotic material from the AAA in the inferior vena cava (IVC) through the ACF. We report a case of a patient admitted to the emergency department with abdominal pain and shortness of breath who immediately underwent thoraco-abdominal CT. Imaging allowed a prompt pre-operative diagnosis of an ACF between an AAA and the IVC, also identifying CT signs of right heart overload and the presence of a paradoxical pulmonary embolism.
Published: 2021
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20. Activities at Thoracic Aortic Research Center, IRCCS Policlinico San Donato

Author: Carlo De Vincentiis, Santi Trimarchi, Alessandro Frigiola, Vincenzo Rampoldi, Marta Cova, Arnoud V. Kamman, Sara Segreti, Michele Conti, Ferdinando Auricchio, Viviana Grassi, Lorenzo Menicanti, Chiara Lomazzi, Massimiliano M. Marrocco-Trischitta, and Simone Morganti
Subjects: Aortic arch, Aortic dissection, 3d printed, Aorta, medicine.medical_specialty, business.industry, General surgery, education, 030204 cardiovascular system & hematology, Aortic arch surgery, medicine.disease, Aortic repair, Aortic disease, Surgery, 03 medical and health sciences, 0302 clinical medicine, medicine.artery, cardiovascular system, Medicine, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business, Research center
Abstract: The Thoracic Aortic Research Center (TARC) of the IRCCS Policlinico San Donato (PSD) aims to promote research on thoracic aortic diseases, to disclose the scientific knowledge and clinical experience and to develop new scientific paths within the Hospital and the aortic community, in collaboration with other national and international centres. Thoracic Aortic Research Center collaborates with many centres in both Europe (e.g. University of Utrecht, the Netherlands) and the USA (e.g. University of Michigan). This has led to multiple highly regarded publications in respected cardiovascular journals and has led to several PhD programmes resulting in doctorate degrees. Within Italy, in association with the Bioengineering School of the University of Pavia, TARC has founded the “BETA-lab” ( B iomechanics for E ndovascular T reatment of the A orta laboratory), where MDs, Bioengineers, and PhD fellows conduct experimental studies using in vitro/ex vivo models of the physiologic aorta and aortic diseases. Furthermore, a database (iCardiocloud) where the medical imaging of cardiovascular patients from the PSD is structured, for in silico analysis utilizing computational fluid dynamics, and in vitro studies using also 3D printed aortic models. With the role of principal investigator or co-investigator, TARC at PSD has been participating in other several projects, including the International Registry of Acute Aortic Dissection, the International Aortic Arch Surgery Study Group, the European Registry of Endovascular Aortic Repair Complications, the ADSORB and ASSIST trials, and the GREAT registry. International collaborations have included also studies on predictors of aortic growth after dissection with the Yale University and University of Virginia, and on aortic biomarkers with the University of Tokyo.
Published: 2016
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21. Computational simulation of TEVAR in the ascending aorta for optimal endograft selection: A patient-specific case study

Author: Simone Morganti, Santi Trimarchi, Michele Conti, Rodrigo M. Romarowski, Viviana Grassi, Massimiliano M. Marrocco-Trischitta, and Ferdinando Auricchio
Subjects: Male, Patient-Specific Modeling, Selection (relational algebra), Computer science, 0206 medical engineering, Finite Element Analysis, Aortic Diseases, Health Informatics, 02 engineering and technology, 030204 cardiovascular system & hematology, Computational simulation, 03 medical and health sciences, Pseudoaneurysm, Blood Vessel Prosthesis Implantation, 0302 clinical medicine, medicine.artery, Ascending aorta, medicine, Humans, Endovascular treatment, Simulation, Aorta, Aged, Open surgery, Endovascular Procedures, Patient specific, medicine.disease, 020601 biomedical engineering, Finite element method, Computer Science Applications, Blood Vessel Prosthesis, Tomography, X-Ray Computed, Aneurysm, False
Abstract: Thoracic endovascular aortic repair of the ascending aorta is becoming an option for patients considered unfit for open surgery. Such an endovascular procedure requires careful pre-operative planning and the customization of prosthesis design. The patient-specific tailoring of the procedure may call for dedicated tools to investigate virtual treatment scenarios. Given such considerations, the present study shows a computational framework for choosing and deploying stent-grafts via Finite Element Analysis, by supporting the device sizing and selection in a real case dealing with the endovascular treatment of a pseudoaneurysm. In particular, three devices with various lengths and materials were examined. Two off-the-shelf devices were computationally tested: one composed of Stainless Steel rings with a nominal length of 60 mm and another one with Nitinol rings and a distal free flow extension, with a nominal length of 70 mm. In third place, a custom-made stent-graft, also with Nitinol rings and containing both proximal and distal bare extensions with a nominal length of 75 mm, was deployed. The latter solution based on patient morphology and virtually benchmarked in this simulation framework, enhanced the apposition to the wall by reducing the distance between the skirt and the vessel from more than 6 mm to less than 2 mm in the distal sealing zone. Our experience shows that in-silico simulations can help choosing the right endograft for the ascending aorta as well as the right deployment sequence. This process may also encourage vendors to develop new devices for cases where open repair is unfeasible.
Published: 2018

22. Capitolo 17, Consistency of predictors of aortic events in uncomplicated Type B aortic dissection

Author: Santi, Trimarchi, Spinelli, Domenico, Viviana, Grassi, and Benedetto, Filippo
Published: 2018

23. Capitolo 14, False lumen thrombosis and Candy-Plug technique

Author: Spinelli, Domenico, Viviana, Grassi, Sara, Segreti, Chiara, Lomazzi, Marta, Cova, Massimiliano Marrocco Trischitta, and Santi, Trimarchi
Published: 2018

24. Real-world Outcomes of Endovascular Repair of Descending Thoracic Aortic Aneurysms – A Report from the Global Registry for Endovascular Aortic Treatment (Great)

Author: Ali Azizzadeh, Hector W.L. de Beaufort, Gilbert R. Upchurch, Santi Trimarchi, Viviana Grassi, Fread A. Weaver, Gabriele Piffaretti, and Chiara Lomazzi
Subjects: medicine.medical_specialty, business.industry, General surgery, medicine, Real world outcomes, Surgery, Cardiology and Cardiovascular Medicine, business
Published: 2019
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25. Commentary: Dynamic Mesenteric Malperfusion in Aortic Dissection

Author: Santi Trimarchi, Himanshu J. Patel, Theodorus M. J. van Bakel, and Viviana Grassi
Subjects: Aortic dissection, medicine.medical_specialty, Aortic Aneurysm, Thoracic, Intestinal ischemia, Type B aortic dissection, business.industry, medicine.disease, Aortic Dissection, Treatment Outcome, Internal medicine, medicine.artery, medicine, Cardiology, Humans, Radiology, Nuclear Medicine and imaging, Surgery, Superior mesenteric artery, Cardiology and Cardiovascular Medicine, business, Ultrasonography, Interventional
Published: 2018
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26. Outcomes Analysis of Endovascular Repair for Giant Abdominal Aortic Aneurysms

Author: Gabriele Piffaretti, Viviana Grassi, Gilbert R. Upchurch, Santi Trimarchi, and Chiara Lomazzi
Subjects: medicine.medical_specialty, business.industry, medicine, Outcome analysis, Surgery, Cardiology and Cardiovascular Medicine, business
Published: 2019
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27. Corrigendum to ‘Pre-operative Color Doppler Ultrasonography Predicts Endovenous Heat Induced Thrombosis After Endovenous Radiofrequency Ablation’ [European Journal of Vascular & Endovascular Surgery 56/1 (2018) 94–100]

Author: Marta Cova, Chiara Lomazzi, Santi Trimarchi, Daniele Bissacco, Viviana Grassi, Ruth L. Bush, and Sara Segreti
Subjects: medicine.medical_specialty, Heat induced, Radiofrequency ablation, business.industry, Endovascular surgery, medicine.disease, Thrombosis, Pre operative, law.invention, law, medicine, Color doppler ultrasonography, Surgery, Radiology, Cardiology and Cardiovascular Medicine, business
Published: 2018
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28. Long-term outcomes of surgical aortic fenestration for complicated acute type B aortic dissections

Author: Bart E. Muhs, Paolo Righini, Santi Trimarchi, Vincenzo Rampoldi, Frederik H.W. Jonker, Viviana Grassi, and Gilbert R. Upchurch
Subjects: Male, medicine.medical_specialty, Time Factors, Percutaneous, Aortography, Blood Vessel Prosthesis Implantation, Ischemia, Interquartile range, medicine.artery, medicine, Humans, Hospital Mortality, Aged, Retrospective Studies, Ultrasonography, Aged, 80 and over, Aortic dissection, Aorta, business.industry, Vascular disease, Middle Aged, medicine.disease, Survival Analysis, Aortic Aneurysm, Surgery, Aortic Dissection, Treatment Outcome, medicine.anatomical_structure, Italy, Female, Radiology, Intercostal space, Tomography, X-Ray Computed, business, Paraplegia, Complication, Cardiology and Cardiovascular Medicine, Vascular Surgical Procedures
Abstract: Introduction Surgical aortic fenestration has been used for treating ischemic complications of acute type B aortic dissection (ABAD). In the current endovascular era, surgical aortic fenestration may serve as an alternative for these patients after percutaneous failure. The purpose of this study is to describe our surgical suprarenal and infrarenal aortic fenestration technique, and to report the long-term outcomes of this approach in the management of complicated ABAD. Methods We retrospectively analyzed the in-hospital and long-term outcomes of 18 patients treated with either suprarenal (n = 10) or infrarenal surgical fenestration (n = 8) for complicated ABAD between 1988 and 2002. Suprarenal fenestration was performed through a thoracoabdominal incision in the 10th intercostal space, whereas patients treated with infrarenal fenestration underwent a midline laparotomy. A longitudinal aortotomy was performed and the true and false lumens were identified, followed by a wide resection of the intimal membrane. Results Median age was 60 years (range, 48-82 years) and 89% (n = 16) were male. The in-hospital mortality was 22% (n = 4), which included two deaths after suprarenal fenestration and two deaths after infrarenal fenestration. In the remaining patients, full visceral, renal, and lower extremity function was recovered, except for 1 patient with paraplegia at admission in which the neurologic deficit was permanent. Median follow-up of the surviving patients was 10.0 years (interquartile range, 12.5; range, 0.5-20 years). During follow-up, none of the patients developed renal or visceral ischemia, or ischemic complications to the lower extremities, and no significant dilatations of the treated aortic segments were noted. Three of 14 patients with ABAD who were discharged alive expired during the follow-up period due to causes unrelated to the surgical procedure. Conclusion Surgical aortic fenestration represents an effective and durable option for treating ischemic complications of ABAD. Actually, this conservative surgical technique may serve as the alternative treatment in case of contraindications or failure of endovascular management of complicated ABAD.
Published: 2010
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29. Preoperative Ultrasound Analysis Can Predict Endovenous Heat-Induced Thrombosis in Patient Candidates for Endovenous Treatment of Superficial Vein Insufficiency

Author: Daniele Bissacco, Chiara Lomazzi, M. Cova, Viviana Grassi, S. Trimarchi, and S. Segreti
Subjects: medicine.medical_specialty, Heat induced, business.industry, Ultrasound, medicine.disease, Thrombosis, Surgery, medicine, Superficial vein, In patient, Radiology, Cardiology and Cardiovascular Medicine, business
Published: 2016
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30. Open fenestration for complicated acute aortic B dissection

Author: Santi, Trimarchi, Sara, Segreti, Viviana, Grassi, Chiara, Lomazzi, Marta, Cova, Gabriele, Piffaretti, and Vincenzo, Rampoldi
Subjects: Art of Operative Techniques, cardiovascular system
Abstract: Acute type B aortic dissection (ABAD) is a serious cardiovascular emergency in which morbidity and mortality are often related to the presence of complications at clinical presentation. Visceral, renal, and limb ischemia occur in up to 30% of patients with ABAD and are associated with higher in-hospital mortality. The aim of the open fenestration is to resolve the malperfusion by creating a single aortic lumen at the suprarenal or infrarenal level. This surgical procedure is less invasive than total aortic replacement, thus not requiring extracorporeal support and allowing preservation of the intercostal arteries, which results in decreased risk of paraplegia. Surgical aortic fenestration represents an effective and durable option for treating ischemic complications of ABAD, particularly for patients with no aortic dilatation. In the current endovascular era, this open technique serves as an alternative option in case of contraindications or failure of endovascular management of complicated ABAD.
Published: 2014

31. Biomarkers in TAA-the Holy Grail

Author: Chiara Lomazzi, Jip L. Tolenaar, John A. Elefteriades, Viviana Grassi, Vincenzo Rampoldi, Santi Trimarchi, Guido H.W. van Bogerijen, and Sara Segreti
Subjects: Genetic Markers, medicine.medical_specialty, Disease, complex mixtures, Thoracic aortic aneurysm, Asymptomatic, Predictive Value of Tests, parasitic diseases, medicine, Humans, Mass Screening, Genetic Testing, Intensive care medicine, Aortic Aneurysm, Thoracic, business.industry, Gene Expression Profiling, medicine.disease, Prognosis, digestive system diseases, Abdominal aortic aneurysm, Holy Grail, Clinical Practice, Natural history, Dissection, Radiology, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Biomarkers
Abstract: Thoracic aortic aneurysm (TAA) is a silent disease, often discovered at a time point that dramatic complications, as rupture and dissection, occur. For the detection of asymptomatic TAA and prevention of such complications, it is essential to have an adequate screening tool. Until now, routine laboratory blood tests have played only a minor role in the screening, diagnosis, tracking and prediction of the natural history of TAAs. However, the knowledge about biomarkers is rapidly expanding in the cardiovascular field, and there are several potential biomarkers that might be implemented into TAA clinical practice in the near future. The most important and promising markers for TAA will be discussed in this overview.
Published: 2013

32. Importance of Refractory Pain and Hypertension in Acute Type B Aortic Dissection Insights From the International Registry of Acute Aortic Dissection (IRAD)

Author: Truls Myrmel, Gabriel Meinhardt, Toru Suzuki, Frederik H.W. Jonker, Dan Montgomery, Reed E. Pyeritz, Patrick T. O'Gara, Viviana Grassi, Christoph A. Nienaber, Stuart Hutchinson, Santi Trimarchi, Jeanna V. Cooper, Jim Froehlich, Thoralf M. Sundt, Gilbert R. Upchurch, Thomas T. Tsai, Bart E. Muhs, Eduardo Bossone, Eric M. Isselbacher, Arturo Evangelista, Kim A. Eagle, Vincenzo Rampoldi, Trimarchi, S, Eagle, Ka, Nienaber, Ca, Pyeritz, Re, Jonker, Fhw, Suzuki, T, O'Gara, Pt, Hutchinson, Sj, Rampoldi, V, Grassi, V, Bossone, E, Muhs, Be, Evangelista, A, Tsai, Tt, Froehlich, Jb, Cooper, Jv, Montgomery, D, Meinhardt, G, Myrmel, T, Upchurch, Gr, Sundt, Tm, Isselbacher, Em, Trimarchi, S., Eagle, K. A., Nienaber, C. A., Pyeritz, R. E., Jonker, F. H. W., Suzuki, T., O'Gara, P. T., Hutchinson, S. J., Rampoldi, V., Grassi, V., Bossone, E., Muhs, B. E., Evangelista, A., Tsai, T. T., Froehlich, J. B., Cooper, J. V., Montgomery, D., Meinhardt, G., Myrmel, T., Upchurch, G. R., Sundt, T. M., and Isselbacher, E. M.
Subjects: Male, medicine.medical_specialty, Internationality, Pain, survival, surgery, Aneurysm, Refractory, Physiology (medical), medicine.artery, medicine, Humans, Hospital Mortality, Registries, Aortic dissection, Aorta, business.industry, Vascular disease, Irad, Middle Aged, medicine.disease, Surgery, Aortic Aneurysm, Aortic Dissection, aorta, medicine.anatomical_structure, Logistic Models, Circulatory system, Acute Disease, Hypertension, Female, Cardiology and Cardiovascular Medicine, business, Vascular Surgical Procedures, Artery
Abstract: Background— In patients with acute type B aortic dissection, presence of recurrent or refractory pain and/or refractory hypertension on medical therapy is sometimes used as an indication for invasive treatment. The International Registry of Acute Aortic Dissection (IRAD) was used to investigate the impact of refractory pain and/or refractory hypertension on the outcomes of acute type B aortic dissection. Methods and Results— Three hundred sixty-five patients affected by uncomplicated acute type B aortic dissection, enrolled in IRAD from 1996 to 2004, were categorized according to risk profile into 2 groups. Patients with recurrent and/or refractory pain or refractory hypertension (group I; n=69) and patients without clinical complications at presentation (group II; n=296) were compared. “High-risk” patients with classic complications were excluded from this analysis. The overall in-hospital mortality was 6.5% and was increased in group I compared with group II (17.4% versus 4.0%; P =0.0003). The in-hospital mortality after medical management was significantly increased in group I compared with group II (35.6% versus 1.5%; P =0.0003). Mortality rates after surgical (20% versus 28%; P =0.74) or endovascular management (3.7% versus 9.1%; P =0.50) did not differ significantly between group I and group II, respectively. A multivariable logistic regression model confirmed that recurrent and/or refractory pain or refractory hypertension was a predictor of in-hospital mortality (odds ratio, 3.31; 95% confidence interval, 1.04 to 10.45; P =0.041). Conclusions— Recurrent pain and refractory hypertension appeared as clinical signs associated with increased in-hospital mortality, particularly when managed medically. These observations suggest that aortic intervention, such as via an endovascular approach, may be indicated in this intermediate-risk group.
Published: 2010

33. Circulating transforming growth factor-beta levels in acute aortic dissection

Author: Vincenzo Rampoldi, Ryozo Nagai, Santi Trimarchi, Toru Suzuki, Kim A. Eagle, Viviana Grassi, Elena Costa, and Daigo Sawaki
Subjects: Marfan syndrome, medicine.medical_specialty, Marfan Syndrome, Aneurysm, Transforming Growth Factor beta, Internal medicine, Medicine, Humans, In patient, Aortic dissection, diagnostic techniques, biology, business.industry, Transforming growth factor beta, aortic disease, medicine.disease, Therapeutic monitoring, Aortic Aneurysm, Aortic Dissection, Cardiology, biology.protein, Cancer research, biomarker, Biomarker (medicine), Cardiology and Cardiovascular Medicine, business, Biomarkers, Transforming growth factor
Abstract: To the Editor: Circulating transforming growth factor (TGF)-beta has received recent attention because it may potentially serve as a biomarker for therapeutic monitoring of aortic remodeling processes in patients with Marfan syndrome ([1,2][1]). TGF-beta and its actions are regulated by the elastic
Published: 2009

34. Commentary: a better understanding of the diagnosis and treatment of isolated abdominal aortic dissections

Author: Viviana Grassi, Gilbert R. Upchurch, Valerio Tolva, Vincenzo Rampoldi, Santi Trimarchi, Trimarchi, S, Tolva, V, Grassi, V, Rampoldi, V, and Upchurch, G
Subjects: medicine.medical_specialty, Aortography, Aortic Rupture, Treatment outcome, Hospital mortality, Risk Assessment, Aneurysm, Dissecting, Risk Factors, medicine, Humans, Radiology, Nuclear Medicine and imaging, Hospital Mortality, Aortic rupture, Vascular Surgical Procedure, medicine.diagnostic_test, business.industry, Risk Factor, Aneurysm dissecting, Aortic Dissection, Tomography x ray computed, Treatment Outcome, Hypertension, Surgery, Radiology, Cardiology and Cardiovascular Medicine, business, Tomography, X-Ray Computed, Vascular Surgical Procedures, Human, Aortic Aneurysm, Abdominal
Published: 2009

35. Descending thoracic and abdominal aortic coarctation in the young: Surgical treatment after percutaneous approaches failure

Author: Viviana Grassi, Alessandro Frigiola, Vincenzo Rampoldi, Valerio Tolva, Santi Trimarchi, Mario Carminati, Trimarchi, S, Tolva, V, Grassi, V, Frigiola, A, Carminati, M, and Rampoldi, V
Subjects: Male, medicine.medical_specialty, Percutaneous, medicine.medical_treatment, Aorta, Thoracic, Aortic Coarctation, Restenosis, Internal medicine, medicine.artery, Angioplasty, medicine, Stent, Thoracic aorta, Humans, Superior mesenteric artery, Right Renal Artery, Treatment Failure, Aorta, Abdominal, Child, Polytetrafluoroethylene, Vascular Surgical Procedure, Aorta, business.industry, medicine.disease, Surgery, Blood Vessel Prosthesis, Stenosis, Blood Vessel Prosthesi, Treatment Outcome, Cardiology, Stents, Female, Cardiology and Cardiovascular Medicine, business, Vascular Surgical Procedures, Angioplasty, Balloon, Human
Abstract: Descending thoracic and abdominal aortic coarctations are characterized by a segmental narrowing that frequently involves the origin of the visceral and renal arteries. Optimal primary treatment is debated, being reported for both surgical and percutaneous complications. We describe our surgical experience with two youths presenting with failure of distal descending aortic stenting and with abdominal aortic coarctation post-balloon angioplasty, and associated thrombosis of a stented right renal artery and stenosis of the origin of the superior mesenteric artery (SMA). In both cases, a longitudinal aortoplasty was performed with a polytetrafluoroethylene (PTFE) patch, using simple aortic cross-clamping. Renal thrombosis and SMA stenosis were managed with eversion technique. In-hospital course was uneventful. Midterm follow-up showed absence of significant restenosis and better control of hypertension. In order to refrain from operating on these patients as long as possible, and also because of the very high risk of a redo-surgery, we think that an initial balloon angioplasty should be considered. Surgical management can be adopted, even after failure of percutaneous treatments, with satisfactory short- and midterm vessels patency.
Published: 2008

36. Endovascular repair of thoracic aortic disease with the EndoFit stent-graft: short and midterm results from a single center

Author: Nadia Mollichelli, Marco Pavesi, Ana Neagu, Cecilia Fantoni, Valerio Tolva, Cristina Sirolla, Luigi Inglese, Massimo Medda, Viviana Grassi, Inglese, L, Mollichelli, N, Medda, M, Sirolla, C, Tolva, V, Grassi, V, Fantoni, C, Neagu, A, and Pavesi, M
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Aortic Diseases, Aorta, Thoracic, Prosthesis Design, Endovascular aneurysm repair, Thoracic aortic aneurysm, Blood Vessel Prosthesis Implantation, Pseudoaneurysm, Postoperative Complications, Aneurysm, Retrospective Studie, Blood vessel prosthesis, medicine.artery, Stent, medicine, Humans, Thoracic aorta, Radiology, Nuclear Medicine and imaging, Hospital Mortality, cardiovascular diseases, Aortic rupture, Aged, Retrospective Studies, Aged, 80 and over, Aortic dissection, business.industry, Middle Aged, Aortic Disease, medicine.disease, Survival Analysis, Blood Vessel Prosthesis, Surgery, Blood Vessel Prosthesi, Treatment Outcome, Disease Progression, cardiovascular system, Female, Stents, Postoperative Complication, Radiology, Cardiology and Cardiovascular Medicine, business, Human
Abstract: PURPOSE To analyze the outcomes of endovascular treatment of thoracic aortic pathologies performed at a single center with the EndoFit thoracic stent-graft system. METHODS From January 2002 to January 2007, 41 patients (33 men; mean age 69.3+/-9.7 years, range 48-84) were treated for thoracic aortic disease with the EndoFit stent-graft system. Patient data were retrieved from a retrospective review of hospital records. Indications for treatment were progression of aneurysm size in atherosclerotic aneurysms (n = 24, mean aneurysm diameter 7.19+/-1.48 cm), acute contained aortic rupture (n = 5), aortic dissection (n = 6), penetrating atherosclerotic ulcers (n = 4), post-traumatic pseudoaneurysm (n = 1), and post coarctation repair aneurysm (n = 1). RESULTS The EndoFit stent-graft was successfully deployed in all 41 patients. The in-hospital and 30-day mortality rate was 7.3% (3 patients). Three (7.3%) postoperative endoleaks were recorded: a proximal type Ia and a distal Ib both resolved spontaneously at 1 and 3 months, respectively. The third patient had a persistent type Ia endoleak; conversion was necessary after 1 year. There was only 1 case of spinal ischemia, with consequent lower extremity weakness; no paraplegia was observed. During a mean 24.8-month follow-up, 2 secondary type Ia endoleaks were treated with additional stent-grafts. There were 7 (17%) deaths during follow-up. At 2 years, overall patient survival by Kaplan-Meier analysis was 70%; aneurysm-related survival was 89%. CONCLUSION Endovascular treatment of vascular disease involving the descending thoracic aorta can be safely performed with the EndoFit thoracic stent-graft system.
Published: 2008

37. Unreliability of depopulated bovine ureteric xenograft for infra inguinal bypass surgery: mid-term results from two vascular centres

Author: M. Fusari, Valerio Tolva, G. B. Bertoni, Santi Trimarchi, Vincenzo Rampoldi, Viviana Grassi, Tolva, V, Bertoni, G, Trimarchi, S, Grassi, V, Fusari, M, and Rampoldi, V
Subjects: Arterial Occlusive Disease, Time Factors, medicine.medical_treatment, Femoral artery, Retrospective Studie, Ischemia, Transplantation, Heterologou, Popliteal Artery, Ultrasonography, Doppler, Color, Medicine(all), medicine.diagnostic_test, Angiography, Critical limb ischemia, Femoral Artery, medicine.anatomical_structure, Treatment Outcome, Bypass surgery, Radiology, medicine.symptom, Infection, Cardiology and Cardiovascular Medicine, Human, medicine.medical_specialty, Transplantation, Heterologous, Arterial Occlusive Diseases, Revascularization, Prosthesis Design, Follow-Up Studie, Graft, Blood Vessel Prosthesis Implantation, Ureter, medicine.artery, medicine, Animals, Humans, Retrospective Studies, Leg, business.industry, Animal, Xenograft, medicine.disease, Popliteal artery, Surgery, Cattle, business, Follow-Up Studies
Abstract: Introduction. We report a two centre experience with a depopulated ureteric xenograft (SGVG 100((R)), CryoLife Inc., GA, USA) for femoropopliteal revascularization in 12 patients with chronic critical limb ischemia. Report. Between 7 days and 18 months after implantation, 10 of 12 patients (1 lost to follow-up) had the graft explanted due to aneurysmal enlargement. At 5 years, only one graft was still patent and showed moderate signs of enlargement. Conclusion. The SGVG 100((R)) is not a safe conduit for femoropopliteal bypass surgery.
Published: 2006

38. Descending aortic diameter of 5.5 cm or greater is not an accurate predictor of acute type B aortic dissection

Author: Alan T. Hirsch, Arturo Evangelista, Himanshu J. Patel, James B. Froehlich, Thoralf M. Sundt, Truls Myrmel, Christoph A. Nienaber, Kim A. Eagle, Frederik H.W. Jonker, Bart E. Muhs, Eric M. Isselbacher, Linda Pape, Vincenzo Rampoldi, Reed E. Pyeritz, Gabriel Meinhardt, Santi Trimarchi, Stuart Hutchison, Joshua A. Beckman, and Viviana Grassi
Subjects: Marfan syndrome, Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, Aorta, Thoracic, Dissection (medical), Marfan Syndrome, Aortic aneurysm, Aneurysm, Internal medicine, medicine.artery, medicine, Thoracic aorta, Humans, Hospital Mortality, Aged, Aortic dissection, Aorta, Aortic Aneurysm, Thoracic, business.industry, Irad, Middle Aged, medicine.disease, Surgery, Aortic Dissection, Cardiology, cardiovascular system, Female, business, Cardiology and Cardiovascular Medicine, Dilatation, Pathologic
Abstract: ObjectiveThe risk of acute type B aortic dissection is thought to increase with descending thoracic aortic diameter. Currently, elective repair of the descending thoracic aorta is indicated for an aortic diameter of 5.5 cm or greater. We sought to investigate the relationship between aortic diameter and acute type B aortic dissection, and the utility of aortic diameter as a predictor of acute type B aortic dissection.MethodsWe examined the descending aortic diameter at presentation of 613 patients with acute type B aortic dissection who were enrolled in the International Registry of Acute Aortic Dissection between 1996 and 2009, and analyzed the subset of patients with acute type B aortic dissection with an aortic diameter less than 5.5 cm.ResultsThe median aortic diameter at the level of acute type B aortic dissection was 4.1 cm (range 2.1–13.0 cm). Only 18.4% of patients with acute type B aortic dissection in the International Registry of Acute Aortic Dissection had an aortic diameter of 5.5 cm or greater. Patients with Marfan syndrome represented 4.3% and had a slightly larger aortic diameter than patients without Marfan syndrome (4.68 vs 4.32 cm, P = .121). Complicated acute type B aortic dissection was more common among patients with an aortic diameter of 5.5 cm or greater (52.2% vs 35.6%, P
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39. Surgical treatment of aortic dissections

Author: Trimarchi, S., Tolva, V., Vincentiis, C., Viviana GRASSI, Pomè, G., Sangiorgi, G. M., Frigiola, A., Menicanti, L., and Rampoldi, V.

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