Pier Luigi Antignani

Nuova Villa Claudia, Rome, Italy · Vascular Center

Introduction: The aim of this review was to assess the evidence supporting an association between asymptomatic carotid stenosis (ACS) with impaired cognitive function due to chronic cerebral hypoperfusion and/or silent cerebral embolization. Evidence acquisition: PubMed/Medline, Embase and the Cochrane databases were searched up to December 1, 2...

Varicose veins (VVs) mostly represent benign disease. However, in some cases, they can lead to serious complications including deep venous thrombosis (DVT) and pulmonary embolism (PE). Besides deteriorated blood flow caused by VVs inflammation is most probably a common denominator of VVs and DVT, which promotes a procoagulant state and thrombus for...

Background: This prospective observational study was aimed at assessing early outcomes of inpatients with isolated distal deep vein thrombosis (IDDVT) and coexisting bleeding. Methods: Patients received enoxaparin 4000 units daily or intermediate doses, and ultrasound surveillance (US). Primary outcomes were extension to the popliteal vein (PDVT...

Classical risk factors play a major role in the initiation and development of atherosclerosis. However, the estimation of risk for cardiovascular events based only on risk factors is often insufficient. Efforts have been made to identify biomarkers that indicate ongoing atherosclerosis. Among important circulating biomarkers associated with periphe...

Background: The optimal antithrombotic (antiplatelet or anticoagulant) treatment of patients undergoing extracranial carotid artery interventions is a subject of debate. The aim of this multidisciplinary document was to critically review the recommendations of current guidelines, taking into consideration the results of recently published studies....

This position paper, written by members of International Union of Angiology (IUA) Youth Committee and senior experts, shows an overview of therapeutical approaches for patients with chronic limb-threatening ischemia (CLTI) and absence of 'standard' solutions for revascularization. The aim was to demonstrate the accurate management of the 'no-option...

Background Current guidelines do not recommend screening for asymptomatic carotid artery stenosis (AsxCS). The rationale behind this recommendation is that detection of AsxCS may lead to an unnecessary carotid intervention. In contrast, screening for abdominal aortic aneurysms is strongly recommended. Methods A critical analysis of the literature...

This position paper, written by members of International Union of Angiology (IUA) Youth Committee, shows an overview of coagulation system and laboratory tests, analysis of medical therapies (older and newer), medication discontinuation/restart recommendations, bridging therapy recommendations, and an overview of hemostatic agents used in the opera...

Cardiovascular disease (CVD) is the leading cause of mortality and disability in developed countries. According to WHO, an estimated 17.9 million people died from CVDs in 2019, representing 32% of all global deaths. Of these deaths, 85% were due to major adverse cardiac and cerebral events. Early detection and care for individuals at high risk coul...

Recomendación 1.1: Compresión después de ablación térmica o escisión de venas safenas. Cuando sea posible, sugerimos que se debe usar compresión (medias elásticas o vendaje) después de procedimientos quirúrgicos o térmicos, para eliminar venas varicosas. [GRADO 2; NIVEL DE EVIDENCIA - C] Recomendación 1.2:Dosis de compresión posterior a ablación té...

International guidelines strongly recommend statins alone or in combination with other lipid-lowering agents to lower low-density lipoprotein cholesterol (LDL-C) levels for patients with asymptomatic/symptomatic carotid stenosis (AsxCS/SCS). Lowering LDL-C levels is associated with significant reductions in transient ischemic attack, stroke, cardio...

Despite the publication of several national/international guidelines, the optimal management of patients with asymptomatic carotid stenosis (AsxCS) remains controversial. This article compares 3 recently released guidelines (the 2020 German–Austrian, the 2021 European Stroke Organization [ESO], and the 2021 Society for Vascular Surgery [SVS] guidel...

Atherosclerosis has a long preclinical phase, and the risk of cardiovascular (CV) events may be high in asymptomatic subjects. Conventional risk factors provide information for the statistical probability of developing CV events, but they lack precision in asymptomatic subjects. This review aims to summarize the role of some widely publicized indic...

Objectives The recommendations of international guidelines for the management of asymptomatic carotid stenosis (ACS) often vary considerably and extend from a conservative approach with risk factor modification and best medical treatment (BMT) alone, to a more aggressive approach with a carotid intervention plus BMT. The aim of the current multispe...

Objectives: The recommendations of international guidelines for the management of asymptomatic carotid stenosis (ACS) often vary considerably and extend from a conservative approach with risk factor modification and best medical treatment (BMT) alone, to a more aggressive approach with a carotid intervention plus BMT. The aim of the current multis...

Peripheral artery disease (PAD) is one of the most frequent manifestations of atherosclerosis with high rates of morbidity and mortality. Platelets and coagulation are involved in the progression of atherosclerosis and thromboembolic complications. PAD patients have increased pro-thrombotic potential, which includes platelet hyperaggregability and...

Background: 70% of patients affected by SARS-COV-2 disease are asymptomatic or with symptoms that not required Hospitalization. A prodromal period lasting about 5 days can be identified. In this phase a patient with a positive swab for viral RNA may or may not evolve towards the phase of symptomatic disease. Methods: In this paper we reviewed th...

Background: isolated distal deep vein thromboses (IDDVT) are frequent; however, their optimal management is still controversial. Methods: we performed a retrospective study on inpatients undergoing ultrasound for suspected deep vein thrombosis (DVT) or with a particular risk profile, during 2016. The study was aimed to assess the frequency of pr...

The development of coagulopathy is emerging as one of the most significant poor prognostic features in COVID-19 pneumopathy. Thromboembolic manifestations such as pulmonary embolism and disseminated intravascular coagulation (DIC) have been reported and resulted in poor prognosis for the patient. Starting from the evidence in the literature, the pu...

Atherosclerosis is a systemic disease affecting multiple arterial territories. Patients with clinical atherosclerotic disease in one vascular bed are likely to have asymptomatic or symptomatic atherosclerotic lesions in other vascular beds. Specifically, peripheral arterial disease (PAD) often coexists with coronary and carotid disease. With progre...

The SARS-CoV-2 infection (COVID-19) is causing an ongoing pandemic and potentially fatal disease. Development of coagulopathy with thrombotic complications such as deep vein thrombosis and pulmonary embolism are emerging as factors for progression to severe disease and death. Also, a markedly increased level of D-dimer, a protein product of fibrin...

Our work concerns the actual problem of spread of SARS- CoV-2 outbreak which requires fast and correct as possible answer. In current scenario, the need of rapid answer put away the imperative of proper methodology. We focus on the serogical immunoassay for diagnosis of Covid-19 as an important weapon not only for diagnostic purpose, but also for e...

The SARS-CoV-2 (COVID-19) is causing a pandemic and potentially fatal disease, actually of global public health concern. Viral infections are known to be associated with coagulation impairment thus thrombosis, hemorrhage, or both, may occur. Understanding the pathophysiological mechanisms underlying the development of coagulation disorders during v...

Since 1980 using the Doppler method, planned by Bartolo, we have studied several patients by means of the measurement of venous pressures, both in orthostatism and in clinostatism. In a normal subject, in orthostatism the value of average pressure is 60 mmHg in the posterior tibial vein, and 60 mmHg in the long saphenous vein. When there are varico...

Background: The study was initiated following the observation of complete recanalization of thrombus in subjects with DVT treated with rivaroxaban after 1-2 weeks. The aim of this observational retrospective study was to evaluate clinically and by means of echo color Duplex, the fibrinolytic effect of rivaroxaban in patients with recent and previo...

Guideline 1.1: Compression after thermal ablation or stripping of the saphenous veins. When possible, we suggest compression (elastic stockings or wraps) should be used after surgical or thermal procedures to eliminate varicose veins. [GRADE - 2; LEVEL OF EVIDENCE - C] Guideline 1.2: Dose of compression after thermal ablation or stripping of the va...

Background: Two point CUS (2-CUS) for the diagnosis of symptomatic proximal DVT overlooks calf vein thrombosis (CVT) overlooks calf vein thrombosis (CVT) indicating the need to repeat 2-CUS after one week, which is not cost-effective. Complete CUS (CCUS) of all deep veins from the groin to the ankle in a single procedure will pick up CVT, proximal...

In all branches of medicine, there is now a trend towards minimally invasiveness, and the same in phlebology field we tend to replace the traditional surgery of the saphenous vein stripping with minimally invasive techniques such as endolaser, radiofrequency and ultrasound guided foam sclerotherapy (UGFS). Among these, the UGFS is the only one to b...

Aim: To study an influence of cytoflavin therapy on the cerebral hemodynamics in patients with various stages of hypertensive disease (HD). Material and methods: One hundred and forty patients with HD, I-III stages, were randomized into 2 groups: patients of group 1 received complex treatment (antihypertensive therapy and cytoflavin), patients o...

Background: The purpose of this paper was to assess the skin microcirculation in patients with leg ulcers through the laser Speckle. Methods: We examined by laser Speckle 15 patients with leg ulcers, 11 men and 4 women. We considered 4 ischemic ulcers, 5 venous ulcers, 4 vasculitic ulcers, 1 post-traumatic ulcer, and, for comparison, a patient with...

Pelvic congestion syndrome (PCS) is one of the most important causes of chronic pelvic pain in women, as a result of pathological venous flow in ovarian and pelvic veins. Ovarian vein dilatation is seen in 10% of women, with probability to develop pelvic congestion syndrome in up to 60% of this population. Ultrasound assessment of the disease is th...

There are excellent guidelines for clinicians to manage venous diseases but few reviews to assess their hemodynamic background. Hemodynamic concepts that evolved in the past have largely remained unchallenged in recent decades, perhaps due to their often complicated nature and in part due to emergence of new diagnostic techniques. Duplex ultrasound...

Pelvic congestion syndrome is an important cause of chronic pelvic pain that develops due to pelvic, but particularly ovarian, vein incompetence. Pelvic pain is one of the frequent reasons for outpatient gynecologic visits. Unfortunately, large and reliable studies on the prevalence of pelvic congestion syndrome do not yet exist; therefore, only in...

The pelvic congestion syndrome definition includes two not so frequently overlapping scenarios: (i) pelvic venous engorgement with lower abdomen symptomatology; and (ii) lower limb varicose veins fed by pelvic escape points that are generally less prone to develop the abdominal clinical manifestation typical for pelvic congestion syndrome. We retro...

Rivaroxaban is an oral, direct factor Xa inhibitor that inhibits free and clot-bound factor Xa and factor Xa in the pro-thrombinase complex. Preclinical studies demonstrated a potent anticoagulant effect of rivaroxaban in plasma as well as the ability of this agent to prevent and treat venous and arterial thrombosis in animal models. During the tre...

Aim: Mesoglycan, composed of natural glycosaminoglycans, is used for treatment in arterial and venous disease for its benefits on endothelial glicocalix. Little is known about mesoglycan impact on endothelial blood flow regulation. We sought to evaluate the effects of mesoglycan intermittently added to back-ground treatments on impairment of endot...

CEAP is a score designed to give a synthetic description of chronic venous insufficiency (CVI). There is a conflict between the original 1996 CEAP classification and the 2004 revision. The former used a detailed anatomical representation in the anatomical A category, while the latter shifted the same codes to the pathological P category, yielding u...

Objective of the study: To describe the rate of pregnant women who accepted or refused to wear therapeutic compression stockings and to compare their evolution. Methods: The observational study was conducted in pregnant women presenting a CEAP CoS to C3S venous disease. Therapeutic compression stockings (BSN medical, UltraSheer Maternity stockings,...

The diagnostic approach to vascular anomalies should include the distinction between vascular tumors (i.e. hemangiomas) and congential vascular malformations (CVMs). This step is based more on history and clinical examination rather than on instrumental evaluation. In children Duplex ultrasound and histology can be helpful to separate hypervasulari...

We studied the usefulness of preoperative resistance index to select patients who will benefit most from renal stenting. Sixty-two patients underwent renal stenting. All had chronic renal insufficiency with serum creatinine values ranging from 1.5 to 2.5 mg/dL and blood urea nitrogen between 80 and 107 mg/dL. All treated renal artery stenosis were...

This paper is the review of the Consensus Document on Intermittent Claudication of the Central European Vascular Forum (CEVF), published in 2008, and and shared with the North Africa and Middle East Chapter of International Union of Angiology and the Mediterranean League of Angiology and Vascular Surgery. The Document presents suggestions for gener...

Aim: The rates of pregnant women with functional symptoms of venous insufficiency who accepted or refused to wear therapeutic compression stockings were evaluated and compared in relation to their clinical evolution and their compliance levels. Methods: The observational study was conducted in pregnant women between 4 and 28 weeks of amenorrhea...

Aim: No study of strong methodology could be found to resolve the controversy of optimal treatment of distal deep venous thrombosis (DDVT). Some inconclusive evidence exists on two approaches to care: anticoagulants and compression therapy or compression therapy and Duplex scanning monitoring. Different studies report propagation to popliteal vein...

Peripheral arterial disease (PAD) is one of the most frequent manifestations of atherosclerosis and is associated with atherosclerosis in the coronary and carotid arteries, leading to a highly increased incidence of cardiovascular events. Major risk factors of PAD are similar to those that lead to atherosclerosis in other vascular beds. However, th...

The current document is intended to define a consensus on the diagnostic guidelines for patients with lymphedema, based upon literature-based evidence, both clinical and investigative. General diagnostic guidelines include systemic evaluation; assessment of venous function; duplex ultrasonography; and lymphoscintigraphy. Proper diagnosis should all...

Aim: Several studies have demonstrated the effective antithrombotic action of mesoglycan to treat chronic venous disease (CVD). The study aimed to assess clinical and quality of life (QoL) (CIVIQ 20 questionnaire) improvements in mesoglycan-treated patients with clinical, etiological, anatomical and pathophysiological (CEAP) stages 2 and 3. Metho...

An observational study of 2 years was promoted by the Italian Association for Cutaneous Ulcers (AIUC) in order to monitor the epidemiology of leg ulcers, the trend of healing and the more frequent therapeutic approaches in lower limb ulcers. Fifty-nine sites in 14 different Italian regions involved in the study, with 1333 enrolled patients (1163 pa...

Chronic venous insufficiency (CVI) is the condition in which one or more veins become unable to fulfill their three specific functions: 1 – drainage from the tissues of toxic substances; – filling of the heart cavities; – thermoregulation of tissues; in any physical activity or position of the subject. What is the event that causes the CVI? Any con...

PROLOGUE A huge lymphedematous limb in the status of elephantiasis with recurrent lymphangitis that I encountered on the first day of internship was my first contact with the vascular pathology. Since then chronic lymphedema has remained my major interest throughout my career as a vascular surgeon with great debt to Professors Carlos Mayall and Mar...

Background Corona phlebectatica (corona) is a clinical sign associated with chronic venous disorders (CVD). It is a good predictor for skin changes indicating a decompensation of the disease. However, it is not yet included in the clinical part of the CEAP classification, mainly due to the lack of operational criteria for its positive diagnosis. A...

How noninvasive investigation has modified our therapeutic approach in vascular medicine PL Antignani Italian Society for Vascular Investigation Noninvasive diagnostic methods have modified our therapeutic decision-making in several vascular diseases. In particular, many forms of surgical treatment, both endovascular and open, are performed base...

The distal vein thrombosis is a special disease poorly studied and actually without consensus on the diagnostic evaluation and on the necessary treatment. Sometimes this disease has a good prognosis, but it can extend to proximal veins and it can progress to pulmonary embolism, especially in its bilateral presentation. The main diagnostic test is c...

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