[Show abstract][Hide abstract] ABSTRACT: Aim. Owing to the increased mean life expectancy of the general population and the gradual diminution of anesthesiological risks, the number of elderly patients (ultraoctogenarians) undergoing aortic vascular surgery for aneurysms, both in election and emergency, increases from year to year. The aim of this study was to evaluate our surgical results in the light of the international literature in an attempt to justify this type of treatment in this particular age range. Methods. Over the past 3 years, a total of 66 ultraoctogenarian AAA patients with a mean age of 83.2 years were surgically treated. Forty-three patients (65.2%) were operated electively and 23 (34.8%) underwent emergency surgery following rupture. The mean ages of the 2 groups were respectively 82.8 and 83.6 years. In the group of patients undergoing elective surgery, endoprosthesis was inserted in 18 cases (41.9%), while the remainder underwent traditional reconstruction. The results were then compared with the group of patients aged under 80, treated during the same period, both in election and in emergency. Results. The overall mortality in the group of 66 octogenarians was 15.2%; 3 deaths (7.0%) occured in election and 7 (30.4%) in emergency surgery. In the group of 530 patients aged under 80, the overall mortality was less than 4%; with 12 out of 470 in election (2.6%) and 9 deaths out of 60 in emergency surgery (15.0%). Conclusion. A careful evaluation of cardiological and anesthesiological risk, combined with appropriate indications for surgery, means that ultraoctogenarian patients can undergo elective surgery to reduce the risk of AAA rupture in this age range, thereby extending life expectancy.
No preview · Article · Jun 2004 · Italian Journal of Vascular and Endovascular Surgery
[Show abstract][Hide abstract] ABSTRACT: Background. Aim of this study is to evaluate the efficacy of treatment with prostanoids (Iloprost or Alprostadil) in patients with peripheral vascular disease that are not suitable for surgical revascularization or redo surgery; moreover we tried to define the role that this kind of drug could assume in the area of therapeutic strategy available at the moment. Methods. We analyzed the results of 185 cases of patients suffering peripheral vascular disease of different etiology all treated at the Day Hospital of our institute from 1/1/1993 to 31/12/2000. Evaluation was carried out on the basis of the clinical picture (healing or reduction of trophic lesions - reduction or disappearance of rest pain - improvement or restoring the ability to walk). Results. Efficacy of this kind of therapy has been established in 71.26% of patients that brought to the end the expected cycle. This is a percentage of great respect, especially in consideration of the very stern situation of the patients that we treated. Interruptions due to the occurrence of uncontrollable side effects were few (5.94%). A therapeutic advantage was found in clearly defined categories of patients (arterial disease not associated with diabetes, clinical picture not very advanced, female gender). IIoprost proved to be superior to Alprostadil both on the whole and in relation to the different pathologies. Conclusions. Our work shows that the use of prostanoids is widely justified in patients with poor or no surgical opportunities, becoming a therapeutic opportunity of alternative reference or complementary to other medical treatments already tested.
No preview · Article · Mar 2003 · Giornale Italiano di Chirurgia Vascolare
[Show abstract][Hide abstract] ABSTRACT: The rupture of an aortic aneurysm is the most frequent and most severe complication, with an incidence of approximately 20-40/100,000 persons each year. The aim of this study was to identify the preoperative, intraoperative and postoperative factors that may influence the mortality rate.
Between January 1996 and December 1999 145 patients underwent emergency abdominal aortic repair surgery. One hundred and twenty-three patients represented a ruptured AAA and 22 a fissured aneurysm. One hundred and thirty-one patients were males and 14 were females; their mean age was 75+/-5.06 years. We selected a number of parameters after a review of the international literature and these were analysed in the two classes of survivors. No statistical analyses were performed on fissured aneurysms owing to the scant number of cases examined.
Mortality was 41.4% (44.7% in ruptured aneurysms alone). The following were negative preoperative prognostic factors: old age, hypertension, ASA V, intraoperative anuria and platelet count <100,000. Intraoperative factors included: hypotension, cardiac arrest, onset of anuria, aortic clamping in more than one site, duration of surgery, quantity of RBC and plasma transfused. The main postoperative variables correlated to mortality were: hypotension, hypothermia, onset of anuria, need for further transfusions, high creatinine levels.
Rapid intervention can minimise mortality in structures with expert teams of surgeons and anesthetists experienced in treating this type of pathology.
No preview · Article · Jun 2001 · Minerva cardioangiologica
[Show abstract][Hide abstract] ABSTRACT: The authors report two cases of internal carotid artery stenosis associated with brain tumors. After the presentation of the rarity of this combination little described in the literature, they point out their therapeutic behaviour explaining their technical decisions.
No preview · Article · Jul 2000 · Minerva cardioangiologica
[Show abstract][Hide abstract] ABSTRACT: Atherosclerotic lesions of the brachiocepfialic trunk are relatively rare compared with other types of vascular diseases. Median sternotomy with direct endothoracic repair is recommended because of good early and long-term results. Nevertheless, this procedure is not without risks such as hemorrhaging, embolism, aortic dissection, infection or death.
This report therefore, describes our experience in intraoperative balloon angioplasty and additional stent placement of isolated stenosis of the brachiocephalic trunk with cerebral protection ensured by common carotid artery clamping. Through an anterolateral cervical approach the right common carotid artery was surgically exposed. After dilating the brachiocephalic trunk and positioning the stent, the vessel was repaired with a continuous suture.
In all patients the dilation of the stenosis of the brachiocephalic trunk and the stent placement were successful without any side-effects. No distal embolism with neurologic events, innominate artery dissection, rupture, occlusion or neck hematoma occurred. All patients were discharged three days after the intervention.
This technique offers a safe, effective approach to stenoses of innominate arteries because it is less invasive than conventional transthoracic or extrathoracic surgery and offers excellent early and mid-term results. We believe that this technique is a safe and effective alternative to conventional surgery.
No preview · Article · Apr 1999 · Minerva cardioangiologica
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to define a correct anesthesiological and surgical approach in patient who present a significant carotid stenosis with contralateral carotid occlusion.
Between 1996 and 1998 in our Department of Vascular Surgery of the Hospital S. Giovanni Battista has been executed 337 Carotid Endoarterectomies (CEA). Of these, 44 patient (13%) had a contralateral internal carotid occlusion. Forty was male (91%), and 4 female (9%). Echo Doppler, angiography, angioTC or angio-RMN and TCD were performed in all patients. In all cases was executed a traditional CEA.
Because of the presence of a large ischaemic cerebral lesion or clamping intolerance 12 operation were performed under general anesthesia (27%). Shunt was used in 15 patients (34%) and patch was used in 10 cases (23%). In 2 cases (4.5%) there was be a thrombosis of the operated internal carotid artery and one patient died (2.3%).
The presence of contralateral internal carotid occlusion with carotid stenosis > 70% increase the risk of peroperative stroke because of the difficulty of collateral cerebral blood flow. The execution of echo Doppler, angiography, angioTC or angioRM and TCD and their evaluation permit to choice the best anesthesiological and surgical treatment. The utilization of narcosis with thiopental protection and shunting reducing the rate of perioperative stroke, but the local anesthesia allows the best monitoring of intraoperative cerebral function. This behaviour was correctly when in patient with contralateral internal carotid occlusion there is an insufficient intracranic vascularization or an extensive ischaemic lesion or clamping intolerance.
No preview · Article · Nov 1998 · Minerva cardioangiologica
[Show abstract][Hide abstract] ABSTRACT: The splenic artery aneurysms usually have an asymptomatic course; their rupture is associated with high mortality. The clinical history and the treatment of two patients with splenic artery aneurysm are reported. Of the two cases, one was asymptomatic, diagnosed with upper abdomen ultrasound, the other one was treated as an emergency because presented with shock. Both patients underwent surgical procedure; ligature of the splenic artery and splenectomy were performed. Early diagnosis is important in these lesions because the progressive enlargement and eventual rupture are the natural history. Ultrasonography (US) and computed tomography (TC) are very helpful as diagnostic tools, however angiography represents the method of choice since it could be the first step of the embolization treatment. If the diameter is more than 2.5 cm surgical treatment must be performed. Ruptures are treated with emergency operations, when possible. In high-risk patients non operative management by selective embolization may be a suitable alternative.
No preview · Article · May 1998 · Minerva cardioangiologica