64 research outputs found
Twenty-three Years of Experience in Aortic Endograft Explantation
No full textTwenty-three Years of Experience in Aortic
Endograft Explantation
Francesca Miceli, MD, PhD,1 Simone Cuozzo, MD, PhD,1 Vincenzo
Brizzi, MD, FEBVS,2 Ombretta Martinelli, MD,1 Enrico Sbarigia, MD1
. 1
Sapienza, Rome, Italy; 2
Centre Hospitalier Universitaire, Bordeaux,
France
Objective: Late open conversion (LOC) after failed endovascular aneurysm repair (EVAR) still represents one of the major challenges in the
endovascular era. We aim to evaluate rates and indications, and periand long- term out-patient mortality of aortic endograft explantation.
Methods: Analysis was performed on a retrospective monocentric database of patients who underwent LOC for aortic endograft failure. Patients
were stratified into two groups according to the etiology of endograft
explantation: endoleak (EL) versus aortic endograft infection (AEGI). We
distinguished the 30-day mortality rate between urgent and elective
LOC procedures.
Results: Over a period of 23 years (January 2000eMarch 2023), 2,458
standard EVAR procedures were performed at our University Hospital
Center. Thirty-four stent-graft explants were performed with an explantation rate of 1.4%. The mean age at explantation was 71.5 6 7.3 years (range,
56e85). The overall average length of time from EVAR to LOC was 43.7 6
37.6 months (range, 0.7e147.4). Sixteen patients (47.1%) underwent
explant for endoleak. Of those, 12 (75%) were in an elective setting, and
4 (25%) in an urgent setting. In the remaining 18 cases, seventeen patients
(50%) underwent LOC for infection, four of which (23,5%) were in an urgent setting (Table 1). Overall mean follow-up time after explantation
was 57.1 6 59.8 months (range, 0.2e190.8). The overall 30-day perioperative mortality rate was 26.5% (EL 31.2%; AEGI 23.5%). The pooled estimate
for 30-day mortality rate was 13.3% for elective- and 87.5% for urgent LOC
(p < .001), beyond the etiology of stent- graft explantation (Fig. 1).
Conclusion: Our study confirms that the incidence of LOC after EVAR is
rare, but is associated with poor outcomes, especially in the urgent
setting.
Author Disclosure: F. Miceli: Nothing to disclose.
Table. Reasons for endograft failure and type of setting for late open
conversion
Total (%)
(N1⁄434)
Elective setting
No. (%)
Urgent setting
No. (%)
Endoleak 16 (47.1) 12 (75) 4 (25)
Type IA 8/16 (50) 5/8 (62.5) 3/8 (37.5)
Type II 6/16 (37.5) 5/6 (83.3) 1/6 (16.7)
Type III 2/16 (12.5) 2/2 (100) -
Infection 17 (50.0) 13 (76.5) 4 (23.5)
Thrombosis 1 (2.9) - 1 (100)
Fig. 30-day mortality was significantly higher in those patients treated
in an urgent setting, beyond the etiology of stent-graft explantatio
Fables, Emblems, and Natural Forms in Leonardo’s Manuscripts, in Pensiero, tecnica, creatività. Leonardo da Vinci e il Rinascimento, Conference Proceedings (Turin, November 7-8, 2019), edited by G. Cuozzo, A. Dall’Igna, S. Ferrari, H. Schwaetzer. Milan-Udine: Mimesis, Bibliotheca Cusana, 9, 2021, pp. 169-187.
No full textThis paper focuses on the interaction between scientific, literary, and artistic research in Leonardo da Vinci’s manuscripts, which aim to examine and represent natural forms. Drawing upon his employment of fables and emblems in scientific contexts, I argue that Leonardo undertakes an aesthetic and philosophical project that uses empirical, diagrammatic, and pictorial strategies toward the investigation of nature. Through case studies on the fables and the emblems of the lily, the butterfly, and the mirror, I show that Leonardo’s textual and visual forms are modeled on a recurrent binary structure. By means of this binary model, which is also echoed in his scientific diagrams, Leonardo illustrates the causes and the consequences of a natural phenomenon. Ultimately, thanks to the interaction of different fields of analysis – such as geometrical transformation of shapes, fables, and emblems – Leonardo is able to reach a truthful representation of Nature
Il progetto EDUFARM. Connubio tra Università e fattorie didattiche
No full textThe theory of action and enactivism make possible to get back the attention on doing, on body and on thinking, beloved to the activist tradition. Especially, the lab didactics has its roots in New Education, which is at the bottom of pedagogi-cal activism that sees a revolution in the educational relationship in the puerocentric paradigm, in which the child becomes the active protagonist of the educational process and not a simple adult action’s passive receiver. Towards, the didactic farm is redefining its role in the educational system to lead to the devel-opment of didactic laboratory in educational practice. The educational value of this pedagogical place can be traced back to three main ideas: the active pedagogy of learning by doing; direct contact with animals and plants in their natural envi-ronment: it allows visitors to acquire knowledge and skills that cannot be learned in urban context; the sensory stimulation of a rich environment that makes the child protagonist of their knowledge. With the Edufarm research project we want-ed to build a laboratory course with didactic farm as setting and learning by doing as the whole project’s “red thread”
Acute Aortic Stent Graft Thrombosis in Patient with Recent COVID-19 Infection
No full textAlthough COVID-19 primarily affects the respiratory system, it can have various effects on other organs, including the cardiovascular system. COVID-19 can lead to a prothrombotic status, promoting blood clotting, which can potentially affect native vessels and implanted devices. The exact mechanisms through which it leads to increased clotting are not yet fully understood but may involve inflammation, endothelial dysfunction, and a hyperactive immune response. In the present report, we describe a case of acute aortic stent graft thrombosis four days after the resolution of SARS-CoV-2 infection. The patient required emergent explantation of the stent graft after the failure of endovascular bailout procedure
Unexpected Complication of a Nitinol-Constrained Balloon Angioplasty (Chocolate) in Rutherford Class 3 Patient Presenting Challenging Aorto-Iliac Anatomy
No full textWe report an unusual complication of Chocolate nitinol-constraining structure after right superficial femoral artery (SFA) angioplasty. The procedure was performed by vascular surgeons in an operating theater equipped by a portable fluoroscopy unit. Under local anesthesia, by a contralateral approach, a 7F introducer sheath was advanced through the proximal portion of the right common iliac artery. Owing to the severe aorto-iliac vessels calcification, it was not possible to place the introducer sheath into a more distal vessel, as planned. After external iliac artery (EIA) stenting (7 × 80 mm Eluvia), SFA obstruction was intraluminal crossed, and a 6 × 120 mm nitinol-constrained balloon (Chocolate; Medtronic) was advanced in place and inflated. Once the balloon came out, the nitinol-constraining structure was not attached to the balloon surface. Under fluoroscopy, the crashed nitinol mesh was identified at distal edge of previously positioned EIA stent. To prevent mesh migration, it was fixed by covering with a 7 × 40 mm stent. The procedure was then successfully completed, as planned. One-month, postoperative computed tomography angiography showed complete expansion of the stents and no significant residual stenosis (>30%) in EIA, and SFA. Chocolate's mesh was still evident between the stent and the iliac artery wall, in absence of further complications. A 3 months follow-up, patient was still completely asymptomatic for claudication
Occidentalizzazione del mondo e suoi limiti in Serge Latouche
No full textIn occidentalization, i.e. the continuous levelling process aimed at planetary dominion, Serge Latouche identifies the very essence of the Western world. Individualism, universalism, performance, and reproducibility are all factors that define the shape of the process, which reaches its hypostatization when the cult of performance and the consciousness of superiority coincide. In turn, the essence of occidentalization resides in human hýbris towards either natural or rational beings. The remedy invoked by the French author is degrowth, a radical metánoia that must occur through the replacement of human hýbris by phrónesis. Degrowth originates in catastrophism: Latouche conceives of catastrophe less as a completed event in itself than a force reconfiguring the whole being, and which therefore expressed the deepest sense of metánoia
Could gender impact on immediate and long-term carotid artery stenting outcome? Insight from an italian single center experience
No full textBackground: Carotid artery stenting (CAS) has become a valid alternative to carotid endarterectomy in stroke prevention. However, female gender is still considered as an independent risk factor for CAS procedures, potentially limiting immediate and long-term benefits. Aim of present study was to evaluate gender differences in CAS submitted patients from an Italian high-volume center.
Material and methods: a retrospective monocentric study has been conducted on 568 patients (366 males and 202 females), submitted to CAS, between January 2000 and December 2019. Besides gender sex, clinical anatomical, and procedural data were collected as possible factors determining the outcome, when associated to sex gender itself. Primary endpoint of this study consisted in evaluating the technical and procedural success ratio, and the incidence of major and minor stroke, transient ischemic attack, acute myocardial infarction (AMI) peri-procedurally and at medium and long term, between the male and the female population. Secondary endpoint of this study consisted in evaluating the percentage ratio of minor complications happening peri-procedurally in both genders.
Results: Male patients were more likely to be octogenarians, clinical history of coronary artery disease, and smokers, while diabetes was more frequent in female patients. Anatomical and plaque morphology features were not different between the two groups. Technical success was obtained in all but two patients (99,6%), while procedural success was 95% (538/566 patients). During the peri-procedural time, no major stroke, 16 minor strokes (2,81%, 2,45% males vs. 3,45% females, P= 0,48), and 11 transient ischemic attack (2,18% males vs. 1,48% females, P= 0,56) were recorded. At a medium follow-up 57 months, 32 stroke (8 major strokes, 24 minor strokes) episodes (5,6%, males 5,7% vs. females 5,4%, P= 0,88), 24 AMIs (4,2%, males 4,6% vs. females 3,46%, P= 0,5;), 13 restenosis (2,8%, males 2,4% vs. females 1,9%, P= 0,71) and 223 deaths (39,2%, males 34,9% vs. females 47%, P= 0,0048) were noted.
Conclusions: Our results showed no differences in immediate, and long-term CAS outcomes between gender. Larger, prospective studies are required to assess the real importance and significance of gender in determining CAS procedures' benefit and outcome
Ovation Alto stent-graft implantation in patient with TASC D aorto-iliac lesion and coexistent AAA - Case report
No full textSteno-obstructive lesion of the iliac axes and coexisting abdominal aortic aneurysm (AAA) are classified as TASC D aorto-iliac lesions. Although open surgical repair remains the gold standard, updates on stent-grafts labeling and technical improvements have resulted in a gradual replacement of open surgical bypass with endovascular treatments, especially in high-risk patients. We report a case of an infrarenal AAA with hostile proximal aortic neck associated with a chronic total occlusion of the left external iliac artery (EIA). Ovation Alto stent-graft implantation (Endologix, Santa Rosa, CA, USA) was performed through the iliac endoconduit, after EIA's retrograde subintimal recanalization with the re-entry IVUS-guided cathete
The profitable relationship among corporate social responsibility and human resource management: A new sustainable key factor
No full textCorporate social responsibility (CSR) has been increasingly investigated assuming several perspectives. In this scenario, human resources and particularly employees are the most relevant groups of stakeholders playing a key role in all kind of organizations. Thus, this paper aims at investigating the profitable connection between CSR and human resource management (HRM). We investigate which factors determine responsible and sustainable practices in the management of the employees’ typology contracts guaranteeing CSR and its principles. The employees’ contract typology is recognized as a sustainable key factor in influencing corporate performance. Through an empirical analysis in the football industry, we investigate if the work contracts’ average duration by football players affects the performance of their clubs. Our results demonstrate that organizations assuming stabilization and long timing in the employees’ contract are going to achieve sustainable performance assuring socially responsible practices and CSR. The awareness of the existence of a correlation between the duration of the contract and the company performance could be exploited by managers of all organizations in identifying the optimal strategy and the effectiveness in the implementation of CSR. Thus, a new sustainable key factor in assuring CSR and HRM is proposed: the employees’ contractual horizon/timing
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