Publications (15)31.17 Total impact
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Article: Midline abdominal wall incisional hernia after aortic reconstructive surgery: a prospective study.
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ABSTRACT: To evaluate rate of formation of midline abdominal wall incisional hernia (MAIH) after elective open repair of abdominal aortic aneurysm (AAA) and revascularization for aortoiliac occlusive disease (AOD). AAA and AOD patients operated electively via a primary midline abdominal incision at our institution over a decade were entered in this prospective study. Patients who had already undergone midline laparotomy or had an MAIH after previous celiotomy were excluded. Patients were examined for MAIH 6-monthly for 2 years, then yearly. We included 1,065 patients who underwent aortic reconstructive surgery (412 with AAA and 653 with AOD). The follow-up (mean ± standard deviation) was 6.4 ± 3.8 years (range, 0.5-12.7). Wounds were closed with a suture length-to-wound length (SL:WL) ratio of at least 4:1 in 58% (239 of 653) of AAA patients and 66% (431 of 653) of AOD patients (P = .01). There were 124 (11.6%) MAIHs, with an incidence of 12.4% (51 of 412) in the AAA group and 11.2% (73 of 653) in the AOD group (P = .62), and 3 (0.4%) wound infections (all among the AOD patients), none of which resulted in MAIH. At multivariate analysis, a SL:WL ratio of <4:1 was the only independent predictor of MAIH in AAA (P = .004) and AOD patients (P < .001). AAA and AOD patients had a similar incidence of MAIH, which seems related to the wound closure technique. A SL:WL ratio of at least 4:1 is recommended. Further clinical studies are required to determine possible technical and perioperative variables that may be modified to decrease the incidence of MAIH development after aortic reconstructive surgery.Surgery 02/2012; 151(6):882-8. · 3.10 Impact Factor -
Article: Carotid endarterectomy protects elderly patients from cognitive decline: a prospective study.
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ABSTRACT: Carotid endarterectomy (CEA) reduces the risk of stroke in selected patients with symptomatic and asymptomatic carotid disease, but its beneficial influence on cognitive performance in the elderly remains debatable. This prospective study sought to determine early and long-term neurocognitive outcomes after CEA for severe unilateral carotid artery stenosis. From July 2006 to December 2008, 75 symptomatic (group A) and 70 asymptomatic patients (group B) aged 65 years and older underwent CEA under general anesthesia. Sixty-eight age- and sex-matched individuals who underwent laparoscopic cholecystectomy during the same period at our institution served as a control group (group H). Patients with contralateral severe carotid stenosis or occlusion and those with dementia, depression, or a history of major stroke were excluded. Cognitive function was assessed using 2 neuropsychological tests (the Mini-Mental State Examination [MMSE] and the Montreal Cognitive Assessment [MoCA]) performed preoperatively (T0) and then 3 (T1) and 12 months (T2) after operation. A change of at least 2 points between the scores at T0 and T2 was arbitrarily considered as clinically significant. At T0, group A revealed significant cognitive impairments in both mean test scores by comparison with group H (P = .005 and P < .01, respectively), whereas there were no significant differences between groups A and B, or between groups B and H. Postoperatively, symptomatic patients had significant improvements in their mean cognitive performance scores in both tests (P < .01 and P < .01, respectively), whereas there were no changes in the asymptomatic and control patients' scores. No significant differences emerged for the MMSE scores in the 3 groups, whereas there was a marginally significant difference in the MoCA scores between groups A and H (P = .08), but not for A versus B or B versus H when clinically significant scores were considered. Our study showed that only elderly symptomatic patients with severe carotid lesions had a significant improvement in cognitive performance scores after CEA, although the benefit was considered clinically not significant. This suggests that CEA does not diminish neurocognitive functions, but it might provide some protection against cognitive decline in the elderly.Surgery 09/2011; 151(1):99-106. · 3.10 Impact Factor -
Article: Predictors of neck bleeding after eversion carotid endarterectomy.
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ABSTRACT: The aim of this study was to identify predictors for neck bleeding after eversion carotid endarterectomy (eCEA). A prospectively compiled computerized database of all primary eCEAs performed at a tertiary referral center between September 1998 and December 2009 was analyzed. The end point was any neck bleeding after eCEA. End point predictors were identified by univariate analysis. Of 1458 eCEAs performed by the same surgeon on 1294 patients under general anesthesia with continuous electroencephalographic monitoring and selective shunting, there were five major and three minor perioperative strokes (0.5%), and no deaths. Neck bleeding after eCEA occurred in 120 cases (8.2%), of which 69 (4.7%) needed re-exploration. Univariate analysis (odds ratio [95% confidence interval]) identified preoperative antiplatelet treatment with clopidogrel (1.77 [1.20-2.62], P = .004), particularly when continued to the day before CEA (3.84 [2.01-7.33], P < .001), and postoperative hypertension (9.44 [6.34-14.06], P < .001) as risk factors for neck bleeding in general and for neck bleeding requiring re-exploration (4.50 [1.85-10.89], P = .001; 15.27 [2.08-104.43], P = .006, and 2.44 [1.12-5.30], P = .02, respectively). An increased risk of neck bleeding in general was associated with clopidogrel plus acetylsalicylic acid (12.00 [2.59-56.78], P = .005), acetylsalicylic acid alone (4.37 [1.99-9.57], P < .001), and ticlopidine (2.49 [1.10-5.63], P = .02) only when they were continued to the day before CEA. No neck bleeding was associated with preoperative treatment with dipyridamole or warfarin, or no medication. No further complications occurred in the patients who underwent re-exploration. The results of this single-center university hospital study show that neck bleeding after CEA is relatively common but is not associated with an increased risk of stroke or death. Preoperative treatment with clopidogrel, particularly when it is continued to the day before surgery, and postoperative arterial hypertension seem to be associated with a higher risk of neck bleeding after CEA, requiring re-exploration in most cases. Other antiplatelet agents appear to be associated with an increased risk of postoperative neck bleeding only if they are continued to the day before CEA. Larger studies are warranted to confirm our findings and prevent this feared surgical complication.Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 06/2011; 54(3):699-705. · 3.52 Impact Factor -
Article: Advanced age is an independent predicting factor for recurrence in patients with N0 colonic cancer.
Journal of the American Geriatrics Society 06/2011; 59(6):1149-51. · 3.74 Impact Factor -
Article: Predictors of electroencephalographic changes needing shunting during carotid endarterectomy.
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ABSTRACT: Carotid endarterectomy (CEA) is associated with a risk of cerebral ischemia during carotid clamping, hence various cerebral protection strategies, including pharmacological management and routine or selective shunting, are commonly available. This study aimed to analyze the results of CEA with intraoperative electroencephalographic (EEG) monitoring to identify factors associated with EEG changes consistent with cerebral ischemia which needed shunting. A prospectively compiled, computerized database of all primary CEAs performed at our institution with EEG monitoring for symptomatic or asymptomatic severe carotid lesions between January 1990 and June 2009 was analyzed. In all, 1,914 CEA procedures were performed on 1,696 patients, of which 218 had staged bilateral CEAs. EEG changes were recorded in 392 patients (20.5%), but a shunt was inserted during 312 CEA procedures (16.3%). Multivariate analysis showed that a symptomatic presentation (odds ratio [OR], 1.37; 95% confidence intervals [CI], 1.07-1.76; p = 0.012), prior stroke (OR, 2.28; 95% CI, 1.66-3.13; p < 0.001), contralateral carotid occlusion (OR, 2.14; 95% CI, 1.18-3.91; p = 0.019), and moderate (<80%) ipsilateral carotid disease (OR, 1.95; 95% CI, 1.08-3.52; p = 0.033) predicted the need for shunting. EEG was an excellent detector of cerebral ischemia and a valuable tool in guiding the need for shunting. Patients who were symptomatic or had a history of stroke, a contralateral carotid occlusion, or an ipsilateral moderate carotid stenosis were more prone to EEG changes consistent with cerebral ischemia. Surgeons should consider EEG changes during clamping as an effective criterion for selective shunting.Annals of Vascular Surgery 11/2010; 24(8):1045-52. · 1.03 Impact Factor -
Article: Infrapopliteal arterial reconstructions for limb salvage in patients aged > or =80 years according to preoperative ambulatory function and residential status.
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ABSTRACT: Although numerous studies have addressed peripheral revascularizations for critical limb ischemia (CLI) in patients aged > or =80 years, few have focused exclusively on infrapopliteal arterial reconstructions. This study aimed to analyze early and long-term outcomes in very elderly patients who underwent surgical infrapopliteal revascularization for CLI according to their pre-operative ambulatory function and residential status. Over an 18-year period, all consecutive patients aged > or =80 years referred to our institution for CLI requiring primary infrapopliteal or inframalleolar arterial reconstruction were enrolled in the study. All procedures were completed by the same surgeon with patients under regional anesthesia. Patency, limb salvage, amputation-free survival, and cumulative survival rates were assessed by Kaplan-Meier analysis. The patient's pre- and postoperative ambulatory function and residential status (at home vs in a nursing home) were also analyzed. The mean follow-up was 6.2 years (range, 0.1-11.5) and was obtained for 98% of patients. In all, 197 patients (134 men; mean +/- SD age, 82.8 +/- 1.7 years) with 201 critically ischemic limbs were enrolled in the study. No deaths or fatal major complications occurred in the peri-operative period (first 30 days); the local complication rate was 6%. After 1 and 7 years, the primary patency rates were 88% and 68%, the limb salvage rates were 96% and 87%, the amputation-free survival rates were 88% and 39%, and the survival rates were 91% and 44%, respectively. At last follow-up or death, 80% of the patients were ambulatory and 20% were not; 80% lived at home and were independent, another 9% lived at home with assistance, and 76% of the sample lived at home and were ambulatory. Infrapopliteal arterial revascularization in the very elderly with CLI proved safe, effective, and durable, confirming that age per se and concomitant comorbidities do not necessarily affect technical and clinical outcomes. Ambulatory function and independent living status are well preserved because, despite a relatively short life expectancy, the majority of very elderly revascularized CLI patients can be expected to spend their remaining years ambulatory and at home. In contrast, patients with poor ambulatory function or who required assistance pre-operatively were less likely to improve their status after limb revascularization despite a successful technical result.Surgery 02/2010; 148(1):119-28. · 3.10 Impact Factor -
Article: Common femoral artery endarterectomy for occlusive disease: an 8-year single-center prospective study.
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ABSTRACT: Only a few operative or interventional studies have addressed the issue of isolated arterial occlusive disease at the femoral bifurcation, the early and late results reportedly being favorable in the former, controversial in the latter. The purpose of this study was to analyze the peri-operative (30-day) and long-term outcomes of isolated surgical endarterectomy in patients with occlusive disease at the common femoral artery (CFA), providing a baseline for comparison with emerging endovascular procedures. Over an 8-year period, all consecutive patients referred to our institution for claudication, rest pain, nonhealing ulcer(s), or minor tissue loss, with imaging findings of CFA occlusive disease (isolated or with additional infrainguinal lesions in the ipsilateral limb) amenable to endarterectomy of the CFA (isolated or combined with a profundoplasty or with the endarterectomy of the superficial or deep femoral artery first tract, not >1 cm long) were enrolled in the study. We excluded all patients with major tissue loss for which a contemporary infrainguinal revascularization was performed because treating the inflow disease alone would not be sufficient to heal the ischemic wound(s) owing to the presence of concomitant femoral and/or distal lesions, inadequate collateralization, or poor runoff. Descriptive demographic data, risk factors, clinical manifestations, and operative details were recorded. Primary patency (PP), assisted PP (APP), and limb salvage (LS) rates, freedom from additional proximal or distal revascularization in the ipsilateral limb, and survival were assessed using Kaplan-Meier life tables. Univariate and multivariate analyses were performed to identify which factors could influence CFA segment patency or other parameters. In all, 117 patients were enrolled and underwent 121 CFA endarterectomies, 60.3% for claudication and 39.7% for critical limb ischemia (CLI); 30 patients were excluded because they underwent a contemporary infrainguinal revascularization. All procedures were performed with patients under regional anesthesia and took an average operating time of 1.3 +/- 0.7 hours. There were no perioperative deaths or major complications, but 8 (6.6%) local complications. A complete follow-up (mean 4.2 years) was obtained in 111 patients (115 limbs). The 7-year PP, APP, and LS rates were 96%, 100%, and 100%, respectively; the 7-year rates of freedom from further revascularization and survival were 79% and 80%, respectively. Operative endarterectomy in patients with claudication or CLI for occlusive CFA disease proved safe, effective, and durable, and should provide a baseline for comparison with endovascular treatment. Proponents of endovascular procedures as a routine alternative treatment option should bear this in mind.Surgery 10/2009; 147(2):268-74. · 3.10 Impact Factor -
Article: Pseudomonas aeruginosa-infected infrarenal abdominal aorta pseudoaneurysm secondary to laparoscopic colorectal surgery: failure of endovascular stent graft treatment after primary open repair failed.
Canadian journal of surgery. Journal canadien de chirurgie 10/2009; 52(5):E193-4. · 1.05 Impact Factor -
Article: Revascularization to an isolated ("blind") popliteal artery segment: a viable procedure for critical limb ischemia.
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ABSTRACT: The purpose of this study was to analyze our experience of bypass procedures to an isolated ("blind") popliteal artery segment (IPAS) to revascularize the perigeniculate arteries in patients with critical limb ischemia (CLI), to establish whether such revascularizations could yield acceptable results in terms of patency and limb salvage (LS) rates. Over a decade, 347 above-knee arterial revascularizations were performed in 293 patients and in 51 (14.7%) of these the outflow vessels were the perigeniculate arteries arising from an IPAS, through a reversed saphenous vein or spliced veins (n = 30, 58.8%; group I) or polytetrafluoroethylene (n = 21, 41.2%; group II) prosthetic grafts. Patency, LS, and survival rates were assessed using Kaplan-Meier life-table analysis. A complete follow-up (range, 0.1-10.4 years; mean, 5.6 years) was obtained in 49 patients. The IPAS was chosen as the last resort in 39 patients (76.5%) because no other infrapopliteal artery was identified as being available at angiography; in 12 patients (23.5%) it was chosen because of an invasive foot infection or ischemic necrosis overlying the dorsalis pedis or the posterior tibial arteries. The study series was mainly male, with significantly more younger patients in group I (72 +/- 1 years vs 74 +/- 5 years, P = .037). Group I had a statistically higher incidence of diabetes mellitus (76.6% vs 47.6%, P = .033), insulin dependence (56.7% vs 28.6%, P = .047) and history of smoking (80% vs 47.6%, P = .016) than group II. None of the patients died in the perioperative period. There were 3 early graft failures (2 in group I), prompting 3 major amputations. Kaplan-Meier analysis identified 5-year patency and LS rates of 51.4 +/- 9.6% and 90 +/- 4.3%, respectively, in the series as a whole, and the 2 groups had comparable 5-year patency, LS and survival rates. Revascularizations to an IPAS can be performed with acceptable results in terms of patency and LS rates, even when there is no infrapopliteal runoff vessel. Finding perigeniculate arteries arising from an IPAS with no tibio-peroneal vessel reconstitution at arteriography does not justify a pessimistic attitude to the performance of such revascularizations for LS.Surgery 05/2009; 145(4):426-34. · 3.10 Impact Factor -
Article: Stapled haemorrhoidopexy (PPH, longo technique) in the elderly
BMC Geriatrics. 01/2009; -
Article: The role of early surgery in the treatment of acute diabetic foot in the elderly: a retrospective review
BMC Geriatrics. 01/2009; -
Article: Octogenarians and nonagenarians with severe symptomatic and asymptomatic carotid disease: does older age indicate "high risk" for carotid endarterectomy?
BMC Geriatrics. 01/2009; -
Article: Difference of site in ulcer lesions of diabetic foot in the elderly
BMC Geriatrics. 01/2009; -
Article: Natural history of common iliac arteries after aorto-aortic graft insertion during elective open abdominal aortic aneurysm repair: a prospective study.
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ABSTRACT: This study aimed to determine the natural history of common iliac arteries (CIAs) after elective open infrarenal abdominal aortic aneurysm (AAA) repair with an aorto-aortic prosthetic graft. All patients who had a straight tube graft inserted during elective AAA repair at our institution between 1995 and 2005 were prospectively followed up with preoperative and postoperative computed tomography (CT) scans to monitor changes in CIA diameter; their latest CT scan was performed in 2007. Based on preoperative CIA diameter, patients were divided into groups A (both CIAs normal, up to 12 mm in diameter), B (at least 1 ectatic CIA, 13-18 mm), and C (at least 1 aneurysmal CIA, 19-25 mm). The mean follow-up was 7.1 years (range, 2.1-12.3 years). Among 201 patients eligible for the study, 92 patients (45.8%) were in group A, 63 patients (31.3%) were in group B, and 46 patients (22.9%) were in group C. Overall, the diameter increased in 119 CIAs (29.6%) by a mean of 1.1, 1.8, and 2.4 mm in groups A, B, and C, respectively. In all, 14 CIAs (5.4%) progressed from "normal" to "ectatic," and 9 CIAs (10.2%) progressed from "ectatic" to "aneurysmal." Three aneurysmal CIAs slightly exceeded the 25-mm threshold, but none of these were repaired. No patients showed a progression or development of occlusive iliac artery disease or required repeat operation because of excessive CIA enlargement. This analysis showed that most CIAs do not expand after tube graft insertion during AAA repair, and when they do, the degree of dilation is minimal. Tube graft insertion during AAA repair is justified even for ectatic or moderately aneurysmal CIAs, and the procedure is safe and durable. The skepticism surrounding its selective use instead of a systematic bifurcated graft placement seems to be unwarranted.Surgery 12/2008; 144(5):822-6. · 3.10 Impact Factor -
Article: Infrapopliteal arterial revascularization for critical limb ischemia: is the peroneal artery at the distal third a suitable outflow vessel?
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ABSTRACT: Though the peroneal artery (PA) often remains patent despite disease or occlusion of other infrapopliteal arteries, there is skepticism about using the terminal PA as the outflow tract in distal revascularizations for limb salvage, especially when a patent inframalleolar artery is available. We analyzed our experience of using the distal PA and inframalleolar or pedal branches arteries as outflow tracts in revascularizations for critical limb ischemia. Over a decade, among 651 infrapopliteal arterial reconstructions performed in 597 patients, the PA was the outflow vessel in 214, its distal third being involved in 69 vein revascularizations (study group). During the same period, 187 vein bypass grafts were performed to 179 inframalleolar and 8 pedal branches arteries (control group). Patency, limb salvage and survival rates were assessed using Kaplan-Meier life-table analysis. Complete follow-up (range, 0.1-10.2 years; mean, 5.8 years) was obtained in 245 (95.7%) patients (66 were in the study group). The distal PA was chosen as the target vessel: (1) because the proximal, mid-PA was occluded or severely diseased and no other adequate inframalleolar or pedal branches arteries were identified preoperatively (n = 30; 43.5%); (2) because an alternative inframalleolar target vessel was present but severely diseased (n = 9; 13%); (3) because of the length limitations of the available vein (n = 12; 17.4%; or (4) because of the presence of invasive infection or necrosis overlying the dorsalis pedis or posterior tibial arteries (n = 18; 26.1%). The study group was significantly younger than the control group (68 +/- 7 years vs 70 +/- 6 years, P = .039), and included significantly more patients with diabetes mellitus (65.2% vs 50.2%, P = .033) and insulin dependence (52.2% vs 37.9%, P = .041), dialysis-dependent chronic kidney disease (5.8% vs 1.1%, P = .047), and history of smoking (75.3% vs 58.2%, P = .012). None of the patients died in the perioperative period. Although the overall need for minor amputation was statistically higher in the PA group (78.2% vs 63.1%, P = .022), especially as concerns partial calcanectomy (8.7% vs 2.1%, P = .026), the proportion of wounds completely healed during the follow-up and the mean time to wound healing were comparable in the two groups. Kaplan-Meier analysis showed comparable long-term patency, limb salvage, and survival rates in the two groups. Revascularization to the distal third of the PA can achieve much the same outcome in terms of patency and limb salvage rates, wound healing rate and timing, as when other inframalleolar or pedal branches are used. The skepticism surrounding use of the terminal PA as an outflow vessel appears to be unwarranted.Journal of Vascular Surgery 06/2008; 47(5):952-9. · 3.21 Impact Factor
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2011–2012
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University of Padua
- Department of Medicine DIMED
Padova, Veneto, Italy
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