1,720,964 research outputs found
An analysis of early and long-term gender-related outcomes after thoracic endovascular aortic repair
No full textObjectives: To evaluate gender-related outcomes during endovascular treatment of thoracic and thoraco-abdominal aortic diseases (TEVAR). Methods: Multicentre, retrospective, observational cohort study. All TEVARs between January 2005 and April 2023 were identified. Primary outcomes were 30-day mortality, and cumulative survival. Secondary outcomes were vascular access complications, and freedom from TEVAR-related reintervention. Interventions performed in male patients were matched to females on the basis of a one-to-one coarsened exact matching. Results: We identified 151 males who were matched with 151 females. Mortality at 30-day was not statistically different between females and males (11.2% vs 11.2%, P = 1.0). At binary logistic regression analysis, duration of intervention (P = 0.001), and emergency TEVAR (P = 0.001) were associated with mortality at 30 days. Gender did not impact access vessel complication rate [n = 6 (4.0%) vs n = 5 (3.3%), P = 1.0]. The median of follow-up was 46 (IQR, 7-84) months with no difference between males and females [median, 50 (11-95) vs 37.5 (3.5-71.2); P = 0.153]. Estimated survival was not statistically different between females and males (Log-rank χ2 = 0.6, P = 0.442; 95% CI: 110.7-207.3). At Cox's regression analysis, gender did not impact overall survival (HR: 0.8, 95% CI: 0.6-1.3, P = 0.450). Estimated freedom from TEVAR-related reinterventions was not statistically different between females and males (Log-rank χ2 = 0.4, P = 0.837; 95% CI: 187.8-219.3). Conclusions: Female gender itself was not associated with worse 30-day mortality and late survival than males with similar access vessel complication as well as TEVAR-related reintervention rate
Cardiac risk after elective endovascular repair for infrarenal abdominal aortic aneurysm, results from the Italian Collaborators for EVAR multicenter registry
No full textObjectives: Major adverse cardiac events (MACEs) were common complications after endovascular aortic repair (EVAR) causing significant post-operative morbidity and mortality. The aim of the study was to evaluate the cardiac risk after elective EVAR for uncomplicated non infected infrarenal abdominal aortic aneurysm (iAAA) in a large multicenter cohort. Materials and methods: This is a multicenter, retrospective, financially unsupported physician-initiated observational cohort study conducted by four academic tertiary referral hospitals from January 2018 to March 2021. Baseline, perioperative, and postoperative information of elective EVARs was evaluated. The primary outcome was the incidence of MACE after EVAR, which was defined as acute coronary syndrome, non-ST-elevation myocardial infarction, unstable angina pectoris, de novo atrial fibrillation, hospitalization for heart failure and revascularization as well as cardiovascular death. Secondary outcomes were one year overall survival (all-cause mortality) and freedom from aorta-related mortality. Comparative analysis was conducted between MACE and overall population and univariate and multivariate logistic regression analyses were used to analyse factors associated with the risk of MACE occurrence and early 1-year mortality. Results: The study has enrolled 497 patients (35 females, 7%) with a mean age of 75.3±7.8 years. MACE rate was 6.4% (32/497, events/patients) and the majority of the events were recorded in the post-operative period (24/32, 75%, overall 24/497, 4.8%). One-year survival from all-cause mortality was 94% (95%CI 91-96) and MACEs population showed a significant lower survival estimation rate (Overall-MACEs, 95.8% [95%CI 93-97] - 67.9% [95%CI 47-82], log-rank 41.950, p= .0001). Freedom from aorta-related mortality was 99.3% (95%CI 98-100). The perioperative needing for red blood cells (RBC) transfusions was strongly related to MACEs occurrence (odds ratio [OR] 2.67, 95%CI 1.52-4.68, p= .001) and one-year mortality (hazard ratio [HR] 2.14, 95%CI 1.48-3.09, p= .0001). Conclusion: MACEs represent a common complication in the post-operative and early period after elective EVAR. Blood loss requiring RBC transfusions is associated with increased post-operative MACEs and early mortality, suggesting that all the efforts should be carried out to reduce the bleeding during and after elective interventions
Outcomes Following Non-operative Management of Thoracic and Thoracoabdominal Aneurysms
No full textBackground Surgical decision making remains difficult in several patients with aneurysmal disease of the descending thoracic (DT) or thoracoabdominal (TA) aorta. Despite previous studies that have investigated aneurysms treated non-operatively using a prospective growth analysis, completeness and accuracy of follow-up were inconsistent. We aim to describe the survival and freedom from adverse aortic events in patients with DT and TA who did not undergo operative repair.Methods This is a single-center retrospective analysis of all patients with either a descending degenerative atherosclerotic or dissection-related DT or TA aortic lesion who were treated non-operatively from April 2002 to December 2016. We studied patients who did not undergo operative repair of descending degenerative atherosclerotic or dissection-related DT or TA aortic lesion. Primary end points were overall survival and freedom from aortic-related mortality (ARM).Results Of the 315 patients diagnosed with DT or TA disease, 56 (18%) did not undergo surgical repair. Mean aneurysm diameter was 65mm +/- 15 (range 50-120; IQR 5.4-7.15). Extent of the aortic aneurysms was DT in 36 (11%) patients and TA in 20 (6%). Median duration of follow-up was 12months (range 1-108; IQR 3-36). Over the course of the study, 41 (73%) patients died for an overall survival rate of 53% +/- 7 at 1year (95% CI 40-65) and 23%+/- 7 at 3year (95% CI 17-42.5). Aortic-related mortality was 27% (n=15), significantly higher in patients with aneurysms >= 60mm [n=13, (39%) vs. n=2, (9%); P=0.025; OR=5.04]. Overall, estimated freedom from ARM was 81%+/- 5.5 at 1year (95% CI 68-89) and 66.5%+/- 9 at 3year (95% CI 48-81). Only TA extent was independently associated with freedom from ARM during the follow-up (P=0.005; HR: 5.74; 95% CI 1.711-19.729).Conclusions Thoracoabdominal extent of the aneurysmal aortic disease is the most important predictor of ARM in unrepaired DT or TA aortic diseases. Mortality from aortic-related events was significantly more premature than mortality from non-aortic-related mortality
Multicenter real-life study on access-related outcomes after EVAR: percutaneous is the way
No full textBACKGROUND: Endovascular aortic repair (EVAR) is the first-line treatment for abdominal aortic aneurysms (AAA) in fit patients. Percutaneous vascular access (pEVAR) allows to ulteriorly decrease the invasivity of EVAR in comparison to surgical femoral cutdown (sEVAR). The aim of this multicentric study was to compare the two access techniques and their impact on operative time, hospitalization, short and long-term complications, and mortality.
METHODS: Baseline and peripoperative data of consecutive patients undergoing standard EVAR in four Italian vascular academic centers collected in the Italian Collaborators for EVAR (ICE) registry have been retrospectively analyzed. The mortality and complication risk have been calculated with dedicated scores (SVS/AAVS score system, ACS risk calculator). Primary outcomes were technical success of percutaneous access, 30-days mortality and access-related perioperative complications. Operative time, length of hospital stay (LOS), 90-day readmission and type of anesthesia were considered as Secondary outcomes.
RESULTS: From January 2018 to February 2021, 608 consecutive patients underwent EVAR: 373 (61.3%) pEVAR and 202 (33.2%) sEVAR; 33 (5.4%) patients who underwent a hybrid approach (one surgical, one percutaneous) were excluded. Operative time (median 80.00 m [IQR 60.00-110.00] vs. 112.50 m [IQR 90.00-144.00], P<0.001), 90-days readmission rate (1.4% vs. 6.9%, P=0.001) and LOS (4.00 days [IQR 3.00-7.00] in pEVAR vs. 5.00 days [IQR 3.25-8.00] in sEVAR, P=0.012) were lower in the pEVAR group. Type of anesthesia (local 71.7%% vs. general 22.8%; P<0.001) was significantly different between the groups. Technical success rate of pEVAR was 97.3% with lower rates of mortality (1.4% pEVAR vs. 6% sEVAR, P=0.004). Early access-related complications had higher rate in sEVAR group, and the difference was significant (5.4% in sEVAR vs. 1.6% in pEVAR, P=0.02).
CONCLUSIONS: Percutaneous access for EVAR is safe and feasible when compared with surgical access with high technical success rate and low complication. The results of our analysis demonstrate that percutaneous access was associated with decreasing operative time, length of hospital stay, the use of general anesthesia and in hospital readmission
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
The Genoa Vascular Biobank: A today resource for future perspectives in vascular research
No full textVariations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
The Genoa Vascular Biobank: A Today Resource for Future Perspectives in Vascular Research
No full textBackground: Biological knowledge and patient care have been significantly improved by the emergence of big data analysis and -omics sciences, requiring high quality standards for biospecimen and data collection. Biobanks are complex and dynamic units designated to fulfill these needs. Objectives: The Genoa Vascular Biobank (GTB-VD) is a collaborative network between the IRCCS Ospedale Policlinico San Martino (Centre of Biological Resources), and the University of Genoa (Vascular and Endovascular Surgery Unit; Anatomic Pathology Unit; Laboratory of Clinical and Experimental Vascular Biology). This work describes workflow, ethic and governance requirements, demographic and clinical characteristics of subjects enrolled in the GTB-VD, and the volume of open or endovascular surgical interventions. Design: The GTB-VD recruits patients undergoing surgical repair for carotid artery stenosis (CS) and abdominal aortic aneurysm (AAA), enrolled on the basis of selection criteria and subdivided for pathology and type of intervention, upon informed consent. Methods: Biospecimens comprise serum, plasma, whole blood, peripheral blood mononuclear cells, and urine (from AAA only), stored at -80°C; lesions from open surgeries are frozen and formalin fixed paraffin embedded. Samples are associated with donor's clinical data through pseudonymization to prevent patient identification. Data accuracy and sample quality are ensured by harmonized standard operative procedures. Results: From 2018 to the end of 2023, 442 CS (distinguished into severe-asymptomatic or symptomatic, displaying a ratio of 5:1) and 214 AAA have been collected. CS is more frequently associated with diabetes and peripheral artery diseases, AAA with pulmonary history, and renal function impairment. Open surgery is more used for CS and endovascular for AAA. Conclusion: The GTB-VD, as organized, represents an "unicum" in our Country; it supports studies to identify molecular targets and biomarkers associated with specific arteriopathy, for developing secondary prevention strategies and minimally invasive, in situ therapies. Collaborative studies and sample sharing are welcome
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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