445 research outputs found
Oral Anticoagulant Therapy and Endovascular Procedures
No full textWe have read with interest the article by Wilensky et al. on “Outcomes after arterial endovascular procedures performed in patients with an elevated international normalized ratio,”1 reporting on the management of patients under oral anticoagulant therapy (OAT).
Although the authors state that no studies were published before their series, the possibility of performing peripheral arterial procedures in patients with OAT was specifically addressed in 2 studies from our institution. Specifically in the articles by Pini et al.2 and Faggioli et al.,3 we have highlighted the results achievable in carotid stenting (CAS) procedures in patients with OAT. In both studies, not only the safety of the procedure was shown, but also the advantages over traditional surgical carotid endarterectomy (CEA) and bridging therapy.
In the first paper, we have analyzed specifically 502 CAS performed in a 5-year period with 12 (2.4%) perioperative strokes, 1 (0.2%) death, no myocardial infarctions, and 4 (0.8%) access site bleeding period. Twenty patients (4.0%) under chronic OAT were submitted to CAS without perioperative bridging heparin therapy and no complications. Overall, patients under OAT had no significantly different outcome compared with patients without OAT.2
In the second paper, we have analyzed altogether 1,222 carotid revascularizations, with 711 CEAs (58.1%) and 511 CAS (41.9%). In the CEA group, 31 (4.4%) OAT patients were treated after OAT interruption and bridging heparin therapy. These patients had a significantly higher complication rate compared with patients not receiving OAT, including death, stroke, and hematoma. In CAS, the results were similar in patients receiving OAT (30[5.8%]) and patients not receiving OAT. Patients receiving unsuspended OAT who underwent CAS had better outcomes than OAT patients who underwent CEA after suppression of OAT and bridging therapy.3
As a matter of fact, our current practice includes stenting as a first option in OAT patients needing carotid revascularization. In this sense, although we advocate standard CEA as the gold standard procedure for symptomatic and asymptomatic carotid disease, there are subgroups of patients (i.e., OAT patients and patients with contralateral carotid occlusion) who benefit more from CAS.
The efficacy of CO2 angiography in the endovascular treatment of an acute iliac pseudoaneurysm
No full textCO2 angiography has been used extensively for the endovascular treatment of aorto-iliac and femoral-popliteal-tibial pathologies, specifically in patients with chronic kidney disease or allergy to iodinated contrast medium (ICM). However, its use in urgent treatment of an acute pseudoaneurysm has never been described before. We report a case of a 39-year-old woman, allergic to iodine, with a recent kidney transplant, who presented in the emergency room with severe pain in the left iliac fossa. Angio CT-scan showed an acute pseudoaneurysm of the left common iliac artery. She was emergently treated with a stent-graft and CO2 was used as main contrast medium. The intraoperative angiographies performed with carbon dioxide showed very well the rupture site and the pseudoaneurysm; the latter were more clearly visible with CO2 compared with ICM. The reported case shows the efficacy of CO2 as contrast medium also in urgent settings and arterial ruptures. The lower viscosity of CO2 probably leads to an easier diffusion through the arterial lesion into the pseudoaneurysmal sac. Therefore, in this case the use of carbon dioxide not only guaranteed prevention of massive allergic reaction to iodine and preservation of postoperative renal function, but also resulted in higher image quality in the operating room
Sistema vascolare
No full textil capitolo tratta le principali patologie del sistema vascolare arterioso e venoso degli arti, anche se le metodiche ultrasonografiche sono utilizzate con maggiore frequenza nell'analisi di altri distretti con rilevanza epidemiologica e patologica spesso preminente, come i tronchi sovraortici e i casi aorto-iliaci. vengono descritti i metodi di indagine ultrasonografica degli arti inferiori e superiori. Successivamente vengono esposte le patolgie vascolari non aterosclerotiche di interesse muscolo-articolare
Carotid disease. Clinical and morphological insights
No full texttHIS BOOK IS THE RESULT OF THE WORK OF MANY OF THE MOST RENOWNED EXPERTS IN THE FIELD, IN AN EFFORT TO SUMMARZE AND ASSESS THE CONTEMPORARY KNOWLEDGE ON THE PATHOLOGY
Phaseolus coccineus storage proteins. II. Electrophoretic analysis and erythroagglutinating activity in various cultivars.
No full textBiochemical analyses of seed storage proteins of Phaseolus coccineus have been carried out to identify seventeen different cultivars. The electrophoretic patterns in native polyacrylamide gel electrophoresis (PAGE) and denaturing conditions (SDS-PAGE); evidenced qualitative and quantitative differences for the three major protein components: legumin, vicilin and phytohaemagglutinin (PHA). The results were confirmed by isoelectrofocusing (IEF) analyses. Erythroagglutination tests showed the presence of high agglutinating activity particularly in cultivars with low vicilin content. The experimental results allow one to distinguish all the cultivars by their electrophoretic spectra and agglutinating activities
Intraoperative contrast enhanced ultrasound adds some important details to the endovascular aortic aneurysm repair completion control
No full textBACKGROUND:
The aim of this study was to evaluate the feasibility and utility of intraoperative contrast-enhanced ultrasound (CEUS) for early detection of endoleaks (ELs) during endovascular abdominal aortic aneurysm repair (EVAR) compared with completion digital subtraction angiography.
METHODS:
Patients undergoing elective EVAR from January 2017 to April 2018 were consecutively enrolled in this prospective study. After endograft deployment, two-digital subtraction angiography (2DSA) with orthogonal C-arm angulations (anteroposterior and sagittal view) were routinely performed. After the endovascular treatment of clear, high-flow type I/III ELs detected by 2DSA, intraoperative CEUS was carried out in sterile conditions on the surgical field before guidewire removal. Presence and type of EL were evaluated with 2DSA and CEUS. CEUS was performed with the vascular surgeon blinded to the 2DSA findings. The primary end point was the level of agreement between 2DSA and CEUS to detect any type of EL and type II EL. Agreement between two diagnostic methods was calculated using Cohen's kappa. The secondary end point was utility of CEUS for intraoperative adjunctive procedure guidance.
RESULTS:
Sixty patients were enrolled (mean age, 78 ± 6 years; 90% male). 2DSA revealed 11 ELs (18%; 1 type IA, 10 type II), and CEUS 25 ELs (42%; 2 type IA, 23 type II). 2DSA and CEUS were in agreement in 39 cases (65%; 32 no ELs, 7 type II ELs). CEUS detected 17 ELs not identified by 2DSA (28%; 2 type IA, 15 type II); 2DSA detected three ELs not identified by CEUS (5%; 3 type II). In one case, 2DSA and CEUS detected type II and type IA ELs, respectively. For EL and type II EL detection, Cohen's kappa was 0.255 and 0.250, respectively (both "fair agreement"). Intraoperative adjunctive sac embolization was performed under CEUS control in 4 cases and technical success was 100%.
CONCLUSIONS:
Intraoperative CEUS during EVAR is feasible and can detect a greater number of ELs than 2DSA, in particular type II ELs. Further studies are necessary to assess the reliability of this intraoperative diagnostic examination. In type II ELs, CEUS may represent an additional, useful tool for intraoperative sac embolization guidance
Revascularisation of Chronic Limb Threatening Ischaemia in Patients with no Pedal Arteries Leads to Lower Midterm Limb Salvage
No full textObjective: Chronic limb threatening ischaemia (CLTI) involving the infragenicular arteries is treated by distal angioplasty or pedal bypass; however, this is not always possible, due to chronically occluded pedal arteries (no patent pedal artery, N-PPA). This pattern represents a hurdle to successful revascularisation, which must be limited to the proximal arteries. The aim of the study was to analyse the outcome of patients with CLTI and N-PPA after a proximal revascularisation.Methods: All patients with CLTI submitted to revascularisation in a single centre (2019 - 2020) were analysed. All angiograms were reviewed to identify N-PPA, defined as total obstruction of all pedal arteries. Revascularisation was performed with proximal surgical, endovascular, and hybrid procedures. Early and midterm survival, wound healing, limb salvage, and patency rates were compared between N-PPA and patients with one or more patent pedal artery (PPA).Results: Two hundred and eighteen procedures were performed. One hundred and forty of 218 (64.2%) patients were male, mean age 73.2 & PLUSMN; 10.6 years. The procedure was surgical in 64/218 (29.4%) cases, endovascular in 138/218 (63.3%), and hybrid in 16/218 (7.3%). N-PPA was present in 60/218 (27.5%) cases. Eleven of 60 (18.3%) cases were treated surgically, 43/60 (71.7%) by endovascular and 6/60 (10%) by hybrid procedures. Technical success was similar in the two groups (N-PPA 85% vs. PPA 82.3%, p = .42). At a mean follow up of 24.5 & PLUSMN; 10.2 months, survival (N-PPA 93.7 & PLUSMN; 3.5% vs. PPA 95.3 & PLUSMN; 2.1%, p = .22) and primary patency (N-PPA 53.1 & PLUSMN; 8.1% vs. PPA 55.2 & PLUSMN; 5%, p = .56) were similar. Limb salvage was significantly lower in N-PPA patients (N-PPA 71.4 & PLUSMN; 6.6% vs. PPA 81.5 & PLUSMN; 3.4%, p = .042); N-PPA was an independent predictor of major amputation (hazard ratio [HR] 2.02, 1.07 - 3.82, p = .038) together with age > 73 years (HR 2.32, 1.17 4.57, p = .012) and haemodialysis (2.84, 1.48 - 5.43, p = .002).Conclusion: N-PPA is not uncommon in patients with CLTI. This condition does not hamper technical success, primary patency, and midterm survival; however, midterm limb salvage is significantly lower than in patients with PPA. This should be considered in the decision making process
sj-png-1-jet-10.1177_15266028221083461 – Supplemental material for Endovascular Treatment of Abdominal Aortic Aneurysm With Severe Angulation of Infrarenal Aortic Neck by Gore Conformable Endograft
No full textSupplemental material, sj-png-1-jet-10.1177_15266028221083461 for Endovascular Treatment of Abdominal Aortic Aneurysm With Severe Angulation of Infrarenal Aortic Neck by Gore Conformable Endograft by Chiara Mascoli, Gianluca Faggioli, Martina Goretti, Enrico Gallitto, Rodolfo Pini, Antonino Maria Logiacco, Andrea Vacirca and Mauro Gargiulo, Prof in Journal of Endovascular Therapy</p
sj-doc-1-jet-10.1177_15266028221083461 – Supplemental material for Endovascular Treatment of Abdominal Aortic Aneurysm With Severe Angulation of Infrarenal Aortic Neck by Gore Conformable Endograft
No full textSupplemental material, sj-doc-1-jet-10.1177_15266028221083461 for Endovascular Treatment of Abdominal Aortic Aneurysm With Severe Angulation of Infrarenal Aortic Neck by Gore Conformable Endograft by Chiara Mascoli, Gianluca Faggioli, Martina Goretti, Enrico Gallitto, Rodolfo Pini, Antonino Maria Logiacco, Andrea Vacirca and Mauro Gargiulo, Prof in Journal of Endovascular Therapy</p
sj-docx-1-jet-10.1177_15266028221126940 – Supplemental material for Carotid Artery Stenting With Double-Layer Stent: A Systematic Review and Meta-Analysis
No full textSupplemental material, sj-docx-1-jet-10.1177_15266028221126940 for Carotid Artery Stenting With Double-Layer Stent: A Systematic Review and Meta-Analysis by Rodolfo Pini, Gianluca Faggioli, Kosmas I. Paraskevas, Federica Campana, Gemmi Sufali, Cristina Rocchi, Sergio Palermo, Enrico Gallitto and Mauro Gargiulo in Journal of Endovascular Therapy</p
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