1,721,000 research outputs found
RIvaroxaban and VAscular Surgery (RIVAS): insights from a multicenter, worldwide web-based survey
No full textRIvaroxaban and VAscular Surgery (RIVAS): insights from a multicenter, worldwide web-based survey
No full textEndoscopy Biopsy Forceps as Tool for Iliac Covered Stent Removal
No full textEndoscopy biopsy forceps is mostly used in the gastrointestinal tract but here it was used to remove a covered iliac self-expandable stent. A 57-year old male previously treated with bilateral iliac covered stenting and double barrel technique on the right iliac side was admitted for acute ischaemia of the right lower limb. Computed tomography showed thrombosis of covered stents on the right side [aorta/common iliac Viabahn 8 × 100 mm; external iliac artery (EIA) Viabahn 7 × 50 mm; internal iliac artery (IIA) 6 × 50 mm; W.L. Gore Medical, Flagstaff, AZ]. A left percutaneous femoral approach and surgical exposure of the right femoral arteries was performed. After distal clamping, an arteriotomy of the common femoral artery allowed the insertion of a large introducer sheath (Flexor 20F; Cook Medical, Bloomington, IN) via a stiff 0.035" guidewire after recanalization of the thrombosed iliac axis. Via this sheath a coaxial endoscopy biopsy forceps (reusable Fenestrated Rat Tooth Alligator Jaw, working length 230cm; Olympus, Center Valley, PA) was inserted to catch the distal edge of the covered self-expandable stent previously deployed in the EIA ([Fig.]), allowing removal of that covered stent. Next, a balloon was inserted and inflated on the left side, and an over-the-wire thrombectomy using a Fogarty 5F arterial embolectomy catheter (Edwards Lifesciences, Irvine, CA). was performed. A larger covered stent (Viabahn 8 × 100 mm) was used to reline the iliac axis. The ostium of IIA was occluded. In conclusion, endoscopy biopsy forceps could be used in “ultima ratio” as a vascular tool for removing covered self-expandable stents via a surgical femoral approach
Open Repair of Ruptured Abdominal Aortic Aneurysms in a High-Volume Tertiary Referral Center: Proposal of a Prediction Model for 30-Day Mortality
No full textObjective: About open surgical repair (OSR) in ruptured abdominal aortic aneurysms (rAAAs), several factors could affect the early outcomes. Some factors are modifiable, such as prompt diagnosis, time between symptoms and surgery, distance from the hospital, and surgical team's expertise. In Literature, a lot of studies identified predictive models to evaluate 30-day outcomes of rAAAs. All these models included preoperative clinical status and laboratory parameters. Aim of the study was to create a prediction model for 30-day mortality in patients underwent open surgical repair (OSR) for ruptured abdominal aortic aneurysm (rAAA) including pre- and intraoperative factors.
Methods: Between January 2007 and December 2020, 222 patients underwent OSR at our tertiary referral university hospital. Retrospective analysis of pre- and intraoperative factors was made by means of univariate analysis. Associations of patient and procedure variables with 30-day mortality rate were sought with multivariate Cox regression analysis. A mortality probability index was created by using a linear combination of all predictive factors multiplied by coefficients of the multiple logistic regression.
Results: Most of patients were male (189, 85.1%) with a mean age of 76.9 ± 8.7 years. Mean operation time was 221 ± 86 minutes. Overall, 30-day mortality rate was 28.8% (64 cases). Multivariate Cox regression analysis reported that age at intervention (>80 years), hypertension, congestive heart failure, chronic obstructive pulmonary disease, resuscitation maneuvers before surgery, loss of consciousness, and operation time >240 minutes were negative predictive factors for 30-day mortality risk (see [Table 1]). Patency of at least one hypogastric artery and infrarenal clamping had a protective role in reducing 30-day mortality rate. The analysis of the mortality index showed a cut-off point of 67.5 with a sensitivity of 81%, specificity of 78%, positive predictive value of 59%, and negative predictive value of 92%. Patients with values less than 67.5 had a 30-day mortality risk of 8.8%, while patient with values over 67.5 had a risk of 60.4%.
Conclusions: Elderly age, hypertension, congestive heart failure, chronic obstructive pulmonary disease, resuscitation maneuvers before surgery, loss of consciousness, and operation time >240 minutes affected 30-day mortality in patients undergoing OSR for rAAA. Patency of at least one hypogastric artery and infrarenal clamping had a protective role. In our mortality probability index a value over 67.5 increased the 30-day mortality risk up to 60%
Archeologia autostradale
No full textIl saggio è la rielaborazione del contributo selezionato da una giuria di esperti, nell'ambito del convegno di studi "Memorabilia, nel paese delle ultime cose", svoltosi nel maggio del 2015, presso l'Accademia di Architettura di Mendrisio e promosso dal coordinamento nazionale della rete PRIN Recycle Italy. Incentrato sul rapporto tra architettura e infratruttura Il saggio valuta l'ipotesi che l'infrastrutura autostradale possa essere soggetta a una rapida trasformazione in reperto archeologico e ne analizza, le conseguenze e i paradossi. Il contributo prende le mosse da una fotografia scattata da Alfred Eisenstaedt nel centro della carreggiata, che in uscita da Torino conduce a Milano. Gli interrogativi posti dalla precoce riduzione dell'autorstrada a reperto sono trattati con ampi riferimenti alla cultura architettonica e a quella materiale. Cui la medesima autostrada appartiene
Riciclare o conservare?
No full textSi riciclano cose inservibili, scartate e abbondanti; si conservano oggetti cari, rari, preziosi. La conservazione presuppone una sospensione o, comunque, una operazione di resistenza all’azione del tempo; il riciclo si inserisce nel flusso della trasformazione, ne costituisce la modalità intrinseca. La prima aspira a una durata “minerale”; l’ultimo si nutre di obsolescenze e rinascite “biologiche”. L’una mira a preservare configurazioni e qualità complesse indipendentemente dal valore d’uso; l’altro processa industrialmente materiali scartati verso stati più basici per offrirli a nuove possibilità d’impiego. La conservazione è fondata sulla memoria, guarda indietro a valori consolidati e alla volontà di traghettarli verso il futuro; il riciclo accelera l’amnesia, rovista nelle discariche alla ricerca di qualcosa che ci possa servire qui e ora. Da una parte troviamo la certezza delle risposte, dall’altra l’urgenza delle domande; oggetti statici e processi dinamici; autonomia vs. eteronomia; paradigma vs. programma; principio di autorità vs. prestazione; forma vs. materia; specifico vs. generico; collezionismo vs. accumulo..
RIvaroxaban and VAscular Surgery (RIVAS): insights from a multicenter, worldwide web-based survey
No full textN/
Early and late effects of suprarenal aortic cross-clamping on kidney function in patients undergoing open surgery for complex abdominal aortic aneurysms
No full textBackground: Aim of this study was to analyze perioperative factors affecting long-term decline of renal function in patients undergoing Open Surgical Repair (OSR) with suprarenal aortic cross-clamping for pararenal/juxtarenal/"short-neck" abdominal aortic aneurysms (AAAs). Methods: Between November 2012 and February 2022, a retrospectively maintained dataset of all consecutive AAAs who underwent OSR was investigated. Elective surgery, suprarenal aortic cross-clamping, and pararenal/ juxtarenal/"short-neck" AAA have been considered eligibility criteria. One-hundred-eighteen patients were included. Early (30-day) outcomes were evaluation of acute kidney injury (AKI), defined either as a decrease in eGFR >50% or as a doubling of serum creatinine at the nadir of patient's kidney function (RIFLE criteria). At follow-up, main primary outcome was freedom from major adverse kidney event (MAKE). Secondary outcomes were survival, and freedom from reintervention(s). Estimated 5-year outcomes were assessed. Multivariate Cox regression analysis was used to evaluate factors affecting MAKE during the follow-up. Results: Complex AAAs were: pararenal in FOUR cases (3.4%), juxtarenal in 58 cases (49.1%), and 'short neck' in 56 cases (47.5%). Bilateral suprarenal was the most common modality of aortic cross-clamping (100, 84.7%). Mean renal ischemia time was 31.5 +/- 12.7 min. At 30 days, mortality rate was 2.5%. During the postoperative period, 19 patients (16.1%) developed AKI. Pre-existing CKD (OR 3.7; 95% CI: 2.9 to 4.6), operation time exceeding 240 minutes (OR 2.8; 95% CI: 2.1 to 3.9), and reinterventions (OR 4.6; 95% CI: 3.5 to 6.1) significantly affected the onset of postoperative AKI. Median duration of follow-up was 48 months IQR 24-84. Estimated 5-year survival, and freedom from reintervention(s) rates were 86.9% (95% CI: 79.3% to 91.2%), and 91.1% (95% CI: 88.5% to 95.4%), respectively. Multivariate Cox regression analysis showed that postoperative AKI was the only predictive factor (OR 7.7; 95% CI: 5.9 to 8.8) to develop MAKEs in no pre-existing CKD patients during follow-up. Conclusions: Pre-existing CKD, operation time >240 minutes, and reinterventions seemed to be risk factors for postoperative AKI in patients undergoing OSR with suprarenal aortic cross-clamping for complex AAAs. Postoperative AKI significantly affected M AKE in no p re-existing CKD patients during follow-up. MAKE seemed to occur starting from the third year of follow-up
Open surgery of common femoral artery occlusive disease: a contemporary review
No full textINTRODUCTION: Endovascular therapy has gradually gaining more importance for the treatment of common femoral artery (CFA) occlusive disease due to satisfactory perioperative outcomes. However, endovascular interventions seem to provide acceptable outcomes only in the short-term period. Endarterectomy still remains the gold standard with well-established mid- and long-term outcomes. The aim of this study was to analyze all appropriate studies about mid- and long-term outcomes of CFA endarterectomy, regardless of the type of technique used in the framework of a narrative contemporary review. EVIDENCE ACQUISITION: This narrative review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The main inclusion criterion was the availability of data on isolated CFA endarterectomy including mid (1-5 years) and long (6-10 years) term results. EVIDENCE SYNTHESIS: Four studies have been selected. In the mid-term period CFA endarterectomy showed an excellent primary patency rate regardless the clinical presentation (up to 95% and 100% in intermittent claudication and chronic limb-threatening ischemia). About the type of reconstruction, a statistically significant difference was found between patchplasty and direct suture in terms of primary patency (97% vs. 89.9%, P=0.02). In the long-term period the overall primary patency rate was about 95%, regardless of the clinical condition (P=0.04). Overall long-term limb salvage rate ranged from 87% to 92%, with a relatively significant difference between intermittent claudication (100%), and chronic limb-threatening ischemia (82%) (P=0.01). CONCLUSIONS: Considering long-term clinical outcomes and the subsequent durability, surgical treatment is still the cornerstone for CFA occlusive disease, regardless of the type of technique used for both endarterectomy and arterial reconstruction. Due to its reduced invasiveness, high-risk patients may benefit from an endovascular-first approach
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