Use of the directional atherectomy for the treatment of femoro-popliteal lesions in patients with critical lower limb ischemia

Femoro-popliteal PTA for the treatment of critical limb ischemia is frequently associated with unsatisfactory procedural success rates while directional atherectomy (DCA) has improved success rate since claudicant patients undergoing percutaneous treatment of femoro-popliteal obstructive disease. The aim of this prospective study is to evaluate the safety, efficacy and procedural success of DCA, at one year, in the percutaneous treatment of femoro-popliteal obstructive disease in patients with critical limb ischemia.Methods. From March 2012 to March 2013 18 consecutive patients with critical limb ischemia were treated with DCA (Turbohawk/ Covidien-ev3 Endovascular Inc., North Plymouth, Minn…

CEA vs CAS

Objectives: Last years registered an increment in the number of endovascular procedures. Traditional carotid endoarterectomy (CEA) is the most performed surgical treatment for carotid stenosis. In symptomatic patients CEA reduces significantly absolute relative risk of stroke and death. In asymptomatic patients AHA guidelines recommend CEA for stenosis 60–99%, if the risk of perioperative stroke or death is <3%. According to 2007 Clinical Expert Consensus Document Carotid Artery Stenting (CAS) should be used in patients at high-risk for CEA or into controlled trials and Cochrane Database of Systematic Reviews does not support a widespread change in clinical practice away from recommending C…

Subintimal recanalization plus protegè Everflex stenting in superficial femoral artery occlusions with critical limb ischemia

Carotid artery stenting in patients with brain meningioma.

The association between carotid artery stenosis and brain meningioma is rather rare. Indeed, data in literature about this association are scarce and potential risks of carotid artery stenting using different protection devices are not known. We describe the endovascular treatment of severe carotid stenosis in two patients with intracranial meningioma.Riassunto L’associazione tra stenosi carotidea e menigioma cerebrale è piuttosto rara. Di conseguenza I dati su questa associazione sono scarsi in letteratura, e non sono noti i rischi potenziali dello stenting carotideo con l’uso di diversi apparati di protezione. Descriviamo il trattamento endovascolare di una stenosi carotidea serrata in du…

Pre and postoperative evaluation of transcranial Doppler pulsatility index of the middle cerebral artery in patients with severe carotid artery stenosis

In the management of severe carotid artery stenosis particular importance must be given to the evaluation of the risk of perioperative cerebral ischemic events. Our study analysed the possible relationship between the pre-operative middle cerebral artery Gosling Index, calculated after transcranial Doppler (TCD), and intra-operative stump pressure (SP), in order to identify patients with higher risk of ischemic accidents. Moreover, we studied pre- and post- operative Gosling Index values in association with possible events during follow-up. In a one-year time lapse 47 patients underwent either carotid endoarterectomy (CEA) or carotid artery stenting (CAS) with proximal embolic protection sy…

La Sindrome Compartimentale Addominale (ACS) dopo chirurgia dell'Aneurisma dell'Aorta Addominale (AAA)

Introduction: The Abdominal Compartment Syndrome (ACS) is a “condition in which increased tissue pressure in a confined anatomic space, causes decreased blood flow leading to ischaemia and dysfunction and may lead to permanent impairment of function” Materials and Methods: between june 2007 and june 2008 we treated surgically 23 cases of AAA (14 in election and 9 in emergency), with indirect intra-abdominal pressure (IAP) monitoring (intra-vescical catheter). Mean age was 68 (64-84) years. Mean transverse diameter was 6,2 cm (min 5,5 e max 9,0). Rise in IAP more then 20 mmHg was considered for surgical decompression. In 1 case we registered preoperatively IAP more than 20 mmHg treated with …

Simultaneous endovascular treatment of multiple peripheral aneurysms

A 69-year-old man with a history of hypertension and severe pulmonary disease had asymptomatic bilateral common iliac and popliteal artery aneurysms. A bifurcated Talent and two Wallgraft stent-grafts were deployed via open femoral arteriotomies to exclude the aneurysms, respectively. The patient had an uncomplicated recovery, with no transfusion need; the hospital stay was 4 days. After a 5-year follow-up, no complication or endoleak has been detected, with patency of endografts and a mean decrease of 15% in aneurysm transverse diameters. Simultaneous endovascular repair should be considered in the treatment of multiple peripheral aneurysms, to avoid sequential conventional or endovascular…

Extra-anatomic iliac to superior mesenteric artery bypass after bridge endovascular treatment for chronic mesenteric ischemia. A case report

A 60 year old patient presenting chronic mesenteric Ischemia (CMI) was managed with superior mesenteric artery (SMA) stenting as bridge therapy to conventional open surgery. At 5 months follow-up, the SMA stent occluded. During this bridge period the patient gained his general condition and the body mass index (BMI) increased from 18 to 22. The patient was managed subsequently with iliac-SMA bypass in C-loop configuration. At 6 months follow-up the bypass is patent, the patient has no CMI symptoms and his BMI is 25. The endovascular approach did not preclude a subsequent conventional open surgery and it can be safely employed as bridge therapy. An improved patient clinical condition, also d…

Expression of inflammation-related genes in human atherosclerotic plaques

Aims: Atherosclerosis is an inflammator y disease which molecular mechanisms are not been completely investigated. Our aim is to perform a wide expression study of inflammation related genes in human atherosclerotic plaques. Methods: The Human Inflammation Array (Applied Biosystems) was used to perform the mRNA quantification of 92 inflammation-related genes in 12 atherosclerotic plaques, their respective adjacent regions (with a lower grade lesion) and 7 healthy ar teries. The principle of the array is the real-time PCR amplification with a TaqMan probe specific for each gene. Data analysis was performed with SDS 2.3 software with the comparative Ct method using the gene beta-2-microglobulin as h…

An evaluation of coronary atherosclerosis using coronary CT in subjects with asymptomatic carotid lesions

The evaluation of coronary lesions in patients with asymptomatic carotid plaque represents a very promising line of research to assess cardiovascular risk and the possible implementation of a more aggressive prevention therapy. METHODS: In this study we enrolled 102 patients with intermediate to high cardiovascular risk but no history of coronary artery disease. The first group, consisting of 51 patients, underwent a Coronary CT scan (CCT-group) as well as carotid ultrasonography. The second group, also consisting of 51 patients, underwent coronary angiography (CA) and carotid ultrasonography. RESULTS: The absence of a statistically significant difference between the involvement of both cor…

Endograft repair of spontaneous infrarenal abdominal aortic dissection

A 71-year-old man with a history of hypertension and a recent myocardial infarction experienced a sudden periumbilical and back pain. Abdominal tenderness was found at physical examination, with no changes in electrocardiogram and serial enzyme determinations. Computed tomographic angiography (CTA) showed a normal thoracic aorta, an infrarenal aortic dissection extending into the left common iliac artery and a contralateral iliac occlusive disease (A, Cover). Although antihypertensive therapy was administered, the patient had persistent pain; subsequently, he underwent endovascular repair with a bifurcated stent graft (Talent, Medtronic Ave, Santa Rosa, Calif) introduced via the left femora…

Paragangliomi cervicali: diagnosi e trattamento

External iliac artery pseudoaneurysm complicating renal transplantation

Objective: To assess the etiology, management and outcome of iliac pseudoaneurysms following renal transplantation. Methods: Eleven patients who underwent repair between 1982 and 2007 were identified. Five (Group 1) presented pseudoaneurysm at the anastomosis of the donor renal and native iliac arteries, and six (Group 2) presented iliac pseudoaneurysm following transplant nephrectomy. Intraoperative cultures and immunohistochemical examinations were obtained from all surgical cases to determine the existence of a relationship between infection or transplant rejection and pseudoaneurysm formation. Results: Endovascular repair (EVR) was used to treat three patients, while eight patients unde…

external iliac artery pseudoaneurysm complicating renal transplantation

Aneurisma dell'aorta addominale e patologia neoplastica associata

L'EVAR negli AAA con neoplasia concomitante

Subintimal stenting for superficial femoral artery long occlusion in patients with critical limb ischemia

Introduction: Subintimal recanalization of chronic totally occluded superficial femoral arteries (SFA) has gained increasing attention as an effective approach for limb salvage in patients with critical limb ischemia (CLI). Use of stents in treating SFA lesions has increased with the intention to improve arterial patency. Our aim was to evaluate the feasibility and mid-term outcomes of subintimal stenting in long occlusions of the SFA in patients presenting CLI. Methods: A retrospective review of consecutive patients admitted to our unit with chronic occlusion of the SFA and CLI between september 2008 and september 2010 was performed. Within this group, the subintimal angioplasty with prima…

SUBINTIMAL RECANALIZATION AND STENTING FOR LONG SUPERFICIAL FEMORAL ARTERY OCCLUSIONS

Objective: To assess the feasibility and mid-term outcome of combined subintimal recanalization and stenting for the treatment of long superficialFebruary, and then Protégé® EverFlexTM) were placed in the whole subintimal space. The number and the length of stents was dictated from the length of the intentional subintimal dissection. The site of re-entry was chosen without compromise the feasibilty of a future bypass grafting. When completion arteriogram revealed residual stenosis, a post-dilatation was performed. Results: Twenty-eight patients (90.3%) underwent successful procedures, whereas two attempts failed because of inability to pass the guidewire through SFA occlusion and one becaus…

carotid endarterectomy versus stenting in patients with contralateral carotid artery occlusion

Mortality of ruptured abdominal aortic aneurysm with selective use of endovascular repair

The aim of this review was to examine the results over a seven-year period of treatment for ruptured abdominal aortic aneurysm (RAAA). From 2002 on, our tertiary referral centre offered both open and endovascular (EVAR) treatment modalities for RAAA. All patients with a proven RAAA who were admitted into our hospital were included. Primary outcome measure was surgical mortality. In total 261 patients were admitted with suspicion of acute AAA. Of these, 175 (67%) had a RAAA, confirmed by computed tomography-scanning or at laparotomy. One hundred and fifty-nine patients (90.9%) were treated, 114 by open repair and 45 by EVAR. Overall mortality of patients treated was 25.2%, with an open repai…

Endoarteriectomia carotidea versus stenting carotideo

THE POSTERIOR APPROACH IN THE REPAIR OF POPLITEAL ARTERY ANEURYSMS: A TWO CENTER EXPERIENCE

Objective: Popliteal artery aneurysms (PAA) are most frequent among peripheral aneurysms. The most commonly performed surgical repair is proximal and distal ligation with a saphenous vein bypass. We aim to report the early and mid-term outcome of surgical repair of popliteal artery aneurysms via a posterior approach. Methods: A retrospective review of consecutive patients who underwent surgical PAA repair in two vascular surgery units between 1998 and 2009 was performed. Within this group, the posterior approach was used in 28 repairs in 26 patients (25 men). All patients had an ultrasound examination. Eighteen patients underwent conventional angiography while CT angiography with 3-D recons…

Trattamento delle steno-ostruzioni della biforcazione aorto-iliaca mediante la tecnica "kissing-stents"

trattamento delle ostruzioni dell'arteria femorale superficiale mediante stents lunghi ad elevata flessibilità: risultati ad 1 anno

Emergency endovascular repair of an acute aortocaval fistula with AAA: Case report and review of the literature

A 72-year-old man with sudden abdominal pain and congestive cardiac failure presented a high-flow aortocaval fistula with a large abdominal aortic aneurysm as detected by Duplex ultrasonography and computed tomography angiography. As the patient’s multiple comorbidities precluded open repair, an emergency left aortouniiliac stent-graft deployment and femoro-femoral crossover bypass grafting were performed. Notwithstanding, incomplete exclusion of the fistula due to a small inflow from the contralateral iliac axis, the patient’s cardiac overload decreased with a rapid resolution of cardiac failure, allowing for a staged ligation of the right iliac artery with a complete occlusion of the aort…

A Multicenter Experience of Three Different "Iliac Branched" Stent Grafts for the Treatment of Aorto-Iliac And/Or Iliac Aneurysms

Background: The aim of study was to assess the safety and effectiveness of 3 different commercial iliac branch devices (IBDs): the Zenith Branch Iliac Endovascular Graft; the Gore Excluder Iliac Branch System and the E-liac Stent Graft System for the treatment of aorto-iliac or iliac aneurysms. Methods: From January 2017 to February 2020, a retrospective reviewed was conducted on a total of 96 patients. Primary endpoint was IBD instability rate at 24 months. Secondary endpoints included onset of any endoleaks, buttock claudication, IBD-related reintervention and all-death rates, postoperative acute kidney, and changes in maximum diameter from baseline of the aortic aneurysmal sac. Results: …

trattamento endovascolare di aneurisma dell'aorta addominale rotto in vena cava inferiore